Although your doctor will check for this, you should speak with your doctor as soon as possible if you have any unexplained sickness, have loss of weight, or feel extremely tired. If you experience any other symptoms which you think may be due to the tablets, please speak with your doctor or pharmacist for further advice. Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital.
Take the container with you, even if it is empty. This medicine is for you. Do not give it to other people even if their condition appears to be the same as yours. If you buy any medicines, check with a pharmacist that they are suitable to take with your other medicines. Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you. Dated March In Feb i got muscle twifches a blood test in april came Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions.
Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.
For details see our conditions. Patients will be excluded if the pain radiates below the gluteal folds in a radicular pattern. Patients with more than two weeks of pain are at increased risk of poor pain and functional outcomes. Patients with more frequent back pain are at increased risk of poor pain and functional outcomes. Contacts and Locations. Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials. More Information. Publications automatically indexed to this study by ClinicalTrials. Ann Emerg Med. Epub Apr 5. National Library of Medicine U. National Institutes of Health U. Department of Health and Human Services.
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Low Back Pain. Phase 4. Study Type :. Interventional Clinical Trial. Actual Enrollment :. Medications provided to patients are encapsulated.
Actual Study Start Date :. Actual Primary Completion Date :. Actual Study Completion Date :. Drug: Metaxalone Metaxalone mg Drug: Ibuprofen mg Ibuprofen Behavioral: Educational intervention Research personnel will provide each patient with a minute educational intervention. Dizziness, drowsiness, confusion Abuse potential. Long elimination half-life; avoid in older patients and in patients with hepatic impairment.
Metaxalone Skelaxin 5. Drowsiness, dizziness, headache, nervousness Leukopenia or hemolytic anemia rare Liver function test elevation rare Nausea, vomiting, and diarrhea rare Paradoxical muscle cramps. Use with caution in patients with liver failure Possible respiratory depression when combined with benzodiazepines, barbiturates, codeine or its derivatives, or other muscle relaxants Less dizziness and drowsiness than other skeletal muscle relaxants FDA pregnancy category C.
Methocarbamol Robaxin 6. Black, brown, or green urine possible Mental status impairment Possible exacerbation of myasthenia gravis symptoms. Possible respiratory depression when combined with benzodiazepines, barbiturates, codeine or its derivatives, or other muscle relaxants FDA pregnancy category C; reports of fetal abnormalities.
Orphenadrine Norflex 7. Anticholinergic effect drowsiness, dry mouth, urinary retention, increased intraocular pressure Aplastic anemia rare GI irritation Confusion, tachycardia, hypersensitivity reaction with high doses. Decreases effect of phenothiazines e. Tizanidine Zanaflex 8 , 9. Dose-related hypotension, sedation, and dry mouth Hepatotoxicity; monitor liver function tests at baseline and one, three, and six months Withdrawal and rebound hypertension may occur in patients discontinuing therapy after receiving high doses for long period of time; tapering is recommended.
All of these drugs may cause increased drowsiness with central nervous system depressants. Caution is advised when prescribing skeletal muscle relaxants in older patients. Estimated cost to the pharmacist based on average wholesale prices rounded to the nearest dollar in Red Book. Montvale, N. Cost to the patient will be higher, depending on prescription filling fee.
Information from references 1 through 9. Among antispasmodic agents, carisoprodol Soma , cyclobenzaprine Flexeril , metaxalone Skelaxin , and methocarbamol Robaxin were among the top drugs dispensed in the United States in The American Pain Society and the American College of Physicians recommend using acetaminophen and nonsteroidal anti-inflammatory drugs NSAIDs as first-line agents for acute low back pain and reserving skeletal muscle relaxants as an alternative treatment option.
Similar recommendations exist in treating tension headaches. Prescription rates for nonspecific back pain revealed that skeletal muscle relaxants accounted for This article presents evidence regarding the use of antispasmodic skeletal muscle relaxants for various musculoskeletal conditions, and appropriate drug selection if a skeletal muscle relaxant is required.
Highlights of contraindications, adverse effects, and drug interactions for these drugs are listed in Table 1. Many of the studies evaluating the effectiveness of skeletal muscle relaxants are hampered by poor methodologic design, including incomplete reporting of compliance, improper or no mention of allocation concealment, not utilizing intention-to-treat methods, and inadequate randomization.
Some evidence appears to support nonbenzodiazepine skeletal muscle relaxants, such as carisoprodol, cyclobenzaprine, orphenadrine Norflex , and tizanidine Zanaflex , for acute low back pain. One fair-quality study showed no difference between metaxalone and placebo. Cyclobenzaprine has been the most heavily studied drug, with consistently proven effectiveness.
Cyclobenzaprine was found to be moderately more effective than placebo, but had more central nervous system adverse effects. The authors also described several limitations of the meta-analysis including inadequate blinding, heterogeneity among studies, and the presence of publication bias. Skeletal muscle relaxants have also been studied as adjunctive therapy to analgesics in treating acute low back pain.
In one open-label study 20 patients , the addition of cyclobenzaprine to naproxen Naprosyn resulted in a statistically significant decrease in muscle spasm and tenderness compared with naproxen alone. Cyclobenzaprine has also been studied in treating fibromyalgia. A meta-analysis of five trials ranging from six to 24 weeks' duration included a total of patients with fibromyalgia. The authors reported that, although cyclobenzaprine moderately improved sleep and pain, the long-term benefits were unknown.
This meta-analysis was limited by a high drop-out rate, short trial duration, few studies having an intention-to-treat design, and inadequate blinding. Strong data comparing skeletal muscle relaxants to each other are scarce. A systematic review evaluated 46 trials head-to-head and placebo-controlled comprising mostly of studies on low back pain or neck syndromes. The placebo-controlled trials included 17 on cyclobenzaprine, six on tizanidine, four on carisoprodol, and four on orphenadrine, and were mostly conducted more than 15 years ago.
The average patient enrollment was less than patients range 12 to patients. In general, all of the drugs were shown to have some benefit. One fair-quality study showed carisoprodol was better than diazepam at improving muscle spasm and global and functional status in patients with low back pain.
A different systematic review did include some studies which were considered to be high quality. Although the evidence for effectiveness of skeletal muscle relaxants in musculoskeletal conditions is limited, strong evidence does exist in terms of toxicity.
Selection of a skeletal muscle relaxant should be individualized to the patient. If there are tender spots over the muscle or trigger points on physical examination, a skeletal muscle relaxant is a reasonable adjunct to analgesic treatment of low back pain. Skeletal muscle relaxants may also be used as an alternative to NSAIDs in patients who are at risk of gastrointestinal or renal complications. Patients with low back pain or fibromyalgia may benefit from treatment with cyclobenzaprine.
Recent evidence showed similar effectiveness at half of its manufacturer recommended dose 5 mg , but with fewer adverse effects. Higher doses of cyclobenzaprine or tizanidine would be appropriate to promote sedation in cases of more severe discomfort or perceived muscular spasm.
Although there appears to be insufficient data on metaxalone and methocarbamol, these may be useful in patients who cannot tolerate the sedative properties of cyclobenzaprine or tizanidine. Of note, methocarbamol costs substantially less than metaxalone. Carisoprodol is metabolized to meprobamate a class III controlled substance and has been shown to produce psychological and physical dependence.
Although all skeletal muscle relaxants should be used with caution in older patients, diazepam especially should be avoided in older patients or in patients with significant cognitive or hepatic impairment. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. She received her doctor of pharmacy degree from Rutgers University College of Pharmacy in New Brunswick, NJ, and completed an inpatient family medicine pharmacy specialty residency at Deaconess Hospital and the St.
Louis College of Pharmacy in St. Louis, Mo. She received her doctor of pharmacy degree from St. Reprints are not available from the authors. Carisoprodol carisoprodol tablet [package insert]. Philadelphia, Pa. Accessed January 14, Chlorzoxazone chlorzoxazone tablet [package insert]. Sellersville, Pa.
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