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. Cyclobenzaprine hydrochloride cyclobenzaprine hydrochloride tablet [package insert]. Corona, Calif. Knowing the activity of the medication helps in understanding the efficacy of drugs. However, the former can also be used as a relief from tetanus spasms. Additionally, in Methocarbamol vs Flexeril Cyclobenzaprine , both prescription medications come in generic forms. Robaxin vs Flexeril comparison is one of the most popular considering their similarities.
To understand more, take a look at the table below:. Even though both of the drugs are under the same drug class, Robaxin vs Flexeril differ in dosages and length of use. Robaxin is usually dosed multiple times a day while Flexeril can be taken once a day. For patients who are wondering, which is better between Methocarbamol vs Cyclobenzaprine, there is no proof yet that any particular muscle relaxant is much more effective than the other. For example, Pharmacists from St.
Eventually, this medication will benefit them more since it causes somnolence compared to Robaxin. Additionally, Cyclobenzaprine may cause more severe adverse reactions such as dehydration, serotonin syndrome, overactive thyroid gland, and possible stroke.
Both Methocarbamol vs Flexeril medications can harm the fetus during pregnancy. While comparing Methocarbamol vs Soma , it is important to note their collective similarity, which is the ability to relieve spasms and pain, as they both come from the same drug class. Additionally, both of these medications are available in different strengths and generic types. Moreover, this medication is unsafe for adults over the age of 65 or under For the medication Soma, medical professionals from North Carolina reported that even Carisoprodol, the generic of Soma, can cause drug dependence and withdrawal.
In terms of side effects, both Methocarbamol vs Soma may cause dizziness, headaches, and somnolence. However, for the drug Soma, there is a possibility for patients using this medication to experience seizures.
So, for patients who are wondering about which is more effective between Methocarbamol vs Soma, doctors from Tulane University claimed that both of these drugs may give the same benefits. The only difference is that there are more adverse effects associated with Soma. Although in Methocarbamol vs Baclofen comparison, both of these medications are under the same drug class called muscle relaxants, these two offer different indications. For those considering the better option between Robaxin vs Baclofen, the former is used mainly for spasticity , as a regimen for individuals suffering from a spinal injury.
However, it may not be considered the first choice for muscle pain. Also, while Robaxin side effects are mainly sedation and fetal risk, that of Baclofen is quite extensive. One advantage of Baclofen in Methocarbamol vs Baclofen comparison is that it can be used as a treatment for the medical condition called Trigeminal Neuralgia , a type of chronic pain in the face.
So, for those wondering which is better in Robaxin vs Baclofen, consider first the other medical conditions of the patient. Robaxin contains methocarbamol and is usually dosed multiple times per day. Flexeril contains cyclobenzaprine and is available in an extended-release form that can be taken once per day. Robaxin and Flexeril are comparable in effectiveness.
Some people may prefer extended-release generic Flexeril for its once-daily dosing. But, Flexeril may also cause more adverse effects like drowsiness and dry mouth. Discuss these treatment options with a doctor to find the best medication for you. There are no adequate studies to show that Robaxin or Flexeril are safe or harmful during pregnancy. These medications should only be taken if their benefits outweigh the risks. Muscle relaxants should only be taken with medical guidance from a doctor.
It is not recommended to consume alcohol while on Robaxin or Flexeril. Alcohol can compound muscle-relaxant side effects such as drowsiness, dizziness, or loss of coordination. According to systematic reviews, almost all muscle relaxers are comparable in effectiveness. Cyclobenzaprine and tizanidine may be more sedating. However, cyclobenzaprine is one of the most studied muscle relaxers with strong evidence for its effectiveness.
Skip to main content Search for a topic or drug. Robaxin vs. Flexeril: Differences, similarities, and which is better for you. By Gerardo Sison, Pharm. Want the best price on Robaxin? Top Reads in Drug vs. Toujeo vs Lantus: Main Differences and S Dulera vs Advair: Main Differences and S Suboxone vs Methadone: Main Differences Looking for a prescription?
Search now! Type your drug name. Brand and generic version available Brand name Flexeril has been discontinued in the US. Other brand names include Amrix and Fexmid. Initial dosage: mg 4 times daily Maintenance dosage: mg 4 times daily, mg 3 times daily, or mg every 4 hours.
Immediate-release tablets: 5 mg three times daily. Dose may be increased to 10 mg 3 times daily. Extended-release capsules: 15 mg once daily. Dose may be increased to 30 mg once daily. Phenelzine Tranylcypromine Isocarboxazid. Phenobarbital Pentobarbital Secobarbital. Amitriptyline Nortriptyline Citalopram Fluvoxamine Sertraline.
0コメント