Drug Uses

Flexeril is a muscle relaxant, used to treat the pain and stiffness of muscle injuries, including strains, sprains and muscle spasms. The active ingredient in Flexeril is cyclobenzaprine.

How Taken

Flexeril comes in 10 mg tablets, and the normal dose in adults is one 10 mg tablet three times daily. You should not exceed a total dosage of 60 mg of Flexeril per day. It might be taken with food if stomach upset occurs. Take Flexeril as directed. Do not increase your dose or take it more often than prescribed.

Warnings/Precautions

Flexeril may not be suitable for all individuals. If you have had any of the following conditions in the past, or are being treated for them now, please inform your doctor. In some cases side effects may be minimized by following your doctor's advice, but you may be advised not to take Flexeril. Before taking this drug, tell your doctor if you have: glaucoma, an overactive thyroid gland, heart disease, difficulty urinating or any allergies. Inform your doctor if you are pregnant or breast-feeding before taking this drug.

Missed Dose

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Possible Side Effects

May cause stomach upset, heartburn, constipation, headache, dizziness or drowsiness or dry mouth the first few days as your body adjusts to the medication. If these symptoms persist or become severe, notify your doctor. Inform your doctor if you develop: muscle stiffness, skin rash, itching, rapid heart rate, swelling of the face, difficulty urinating. When rising quickly from a sitting or lying position, dizziness or lightheadedness may occur. Change positions slowly and use caution on stairs. Avoid activities requiring alertness if dizziness or drowsiness occurs. If you notice other effects not listed above, contact your doctor or pharmacist.

Storage

Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F) and out of reach of children.

Overdose

The following symptoms indicate an overdose, get medical help immediately: difficulty breathing, extreme nervousness or restlessness, flushed skin, hallucination, racing or irregular heartbeat, seizure, shortness of breath, tiredness (extreme), unstable temperature, unusual muscle stiffness, vomiting (in combination with these other symptoms).

More Information

Flexeril may enhance the effects of alcohol, barbiturates, and other CNS depressants.

Disclaimer

This drug information is for your information purposes only, it is not intended that this information covers all uses, directions, drug interactions, precautions, or adverse effects of your medication. This is only general information, and should not be relied on for any purpose. It should not be construed as containing specific instructions for any particular patient. We disclaim all responsibility for the accuracy and reliability of this information, and/or any consequences arising from the use of this information, including damage or adverse consequences to persons or property, however such damages or consequences arise. No warranty, either expressed or implied, is made in regards to this information.

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RANCHO MIRAGE, CALIF. -- An antispasticity drug, tizanidine, appeared to be effective in treating analgesic rebound headache, chronic tension-type headache, and related pain disorders in several retrospective or open-label prospective trials.
Response to treatment with tizanidine (Zanaflex) for chronic daily headache did not seem to differ in patients based on whether or not they had musculoskeletal symptoms such as spasticity, Dr. Timothy, R. Smith said at a meeting sponsored by the Diamond Headache Clinic.
He conducted a retrospective review of 53 patients at his clinic treated for chronic daily headache that was thought to be caused by analgesic overuse.
The patients were given tizanidine (2 mg to start, titrated up as tolerated), together with a once-daily long-acting NSAID (naproxen) or COX-2 inhibitor (Celecoxib), while eliminating other analgesics.
After 12 weeks, 38 patients (71%) stopped having chronic daily headache and reverted to intermittent headaches, said Dr. Smith of Ryan Headache Center, Chesterfield, Mo.
A separate retrospective review of charts and headache diaries for 62 patients with chronic daily headache found no association between response to tizanidine and the presence of musculoskeletal symptoms, suggesting that the drug's effects on headache are due to factors other than muscle relaxation, he added.
The drug reduced the frequency of headache by at least half in 46 (74%) of patients, 34 (74%) of whom had muscle spasticity at baseline. Muscle spasticity was pre sent in 11 (69%) of nonresponders, a rate that was not significantly different from the responders group, Dr. Smith reported.
"The presence of musculoskeletal symptoms could not predict a clinical response to tizanidine," he said.
Elan Pharmaceuticals, the maker of tizanidine, funded the studies. Dr. Smith has served on the speaker's bureau for Elan Pharmaceuticals and for eight other drug companies.
A separate review of poster presentations on tizanidine at previous medical meetings found four small uncontrolled studies suggesting benefit from treating certain pain syndromes with the drug, Dr. Gary E. Ruoff reported in a separate poster presentation at the meeting.
His review also was funded by Elan Pharmaceuticals. Dr. Ruoff serves on the speaker's list for Elan and five other drug companies.
One open-label trial by Dr. Smith and his associates used 3.6 mg tizanidine daily in 70 patients with analgesic rebound headache who were transitioning to decreased NSAID use, Dr. Ruoff reported.
After 12 weeks, 46 patients (66%) discontinued their chronic NSAID use without worsening headaches. Three patients (4%) experienced treatment-limiting adverse effects, said Dr. Ruoff, who is in practice in Kalamazoo, Mich.
A second open-label trial of 220 patients with recalci- trant chronic tension-type headache who were titrated up to a mean dose of 26 mg tizanidine daily found a response after 10 weeks in 150 patients (68%), reducing headache frequency by a mean of 73%.
In this study, 13 patients (6%) experienced treatment-limited adverse effects.
A third open-label trial of 4-8 mg tizanidine daily in 26 patients with fibromyalgia found decreases on average in the number of tender points, improvements in global assessment scores, Fibromyalgia Impact Questionnaire scores, and visual analog scores after 8 weeks.
In a retrospective chart review, 20 patients who had traumatically induced myofascial pain were given 2-6 mg tizanidine three times daily. Improvements in pain symptoms--including headache--were noted in 14 of the patients (70%) after 4-6 weeks. The drug was well tolerated.
Tizanidine is an imidazoline derivative, an [[alpha].sub.2]-agonist that is structurally related to clonidine.
Many patients with chronic daily headache are thought to have a down regulation of norepinephrine receptors caused by excessive release of norepinephrine from the locus ceruleus.
Tizanidine has been shown to decrease norepinephrine release in the central nervous system. This effect may help restore the homeostatic balance of norepinephrine, thereby reducing patients' perception of pain, Dr. Ruoff speculated.

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