CNS primarily the brain stem to reduce tonic somatic motor activity influencing both gamma and alpha motor neurons leading to a reduction in muscle spasm.
| Acute spasm/pain, centrally acting | |||
| Medication | Dose range | Labs / monitor | Side effects |
| Carisoprodol/Soma | 250-350mg. | Addictive | |
|
Cyclobenzaprine/Flexeril
|
5-10mg taken at bedtime. | Contraindicated for heart failure, glaucoma and seizures. Careful with TCAs, since it has a similar structure | |
|
Baclofen/Lioresal
|
Start at 5mgTID; increase by 5mg q2-3 days to max of 80mg/day. | caution dependence | ataxia, dizziness mental confusion. DO NOT discontinue abruptly b/c of chance of hallucinations, anxiety and tachycardia. |
| Metaxalone/Skelaxin | 800mg 3-4 times a day | Rapid onset short acting, do not take if you have seizures, kidney or liver disease, blood disorders. Do not take with other CNS depressants. Not for pts over 65. | |
|
Methocarbamol/Robaxin
|
500mg-750mg) At first, three tablets of 500 milligrams (mg) or two tablets of 750 mg (total dose of 1500 mg) four times a day. | Headache, confusion, nausea, insomnia, blurred vision. Do not take with other CNS depressants | |
| Tizanide/Zanaflex. | 2-4mg in divided dose. Max dose 24mg/day. Start 1 tab at night, then do one at noon, then one in the morning | Lightheadedness, hyperactivity, severe drowsiness, seizures, hostility. Do not use Benzos with CNS depressants, antihistamines, anticonvulsants, SSRI or alcohol. | |
Comments
Carisoprodol/Soma. Good for musculoskeletal pain where spasm are not present.
Cyclobenzaprine/Flexeril. Good for musculoskeletal pain where spams are not present; it is structured like a TCA.
Baclofen/Lioresal. Good for liver disease patients because it is excreted unchanged in kidney. Good for TN, MS, spinal cord injuries and myofascial.
Methocarbamol/Robaxin. Unknown MOA.
Tizanide/Zanaflex. Good for muscle spasms for MS and spinal cord injuries.
| Other medications used for spasticity | |||
| Medication | Dose range | Labs / monitor | Side effects |
| Benzodiazepam/Valium | 2mg to 10mg, 2 to 4 times daily. | lightheadedness, hyperactivity, severe drowsiness, seizures, hostility Do not use Benzos with CNS depressants, antihistamines, anticonvulsants, SSRI or alcohol | |
| Buspirone/Buspar |
7.5mg 2x/day. Do not exceed more than 60mg/day.
Give with SSRI if pt clenches |
May take 1-2 weeks before effect is felt.
|
Anti-depressive effects. Do not eat grapefruit while taking this med. |
Comments
Benzodiazepam/Valium. Truly lipophilic and crosses the blood brain barrier. It is unique in that it has true muscle relation effects at a dose equal or less than the amount causing a reduction in anxiety. Acts on spinal cord post synaptic inhibition through GABA -Treats anxiety, muscle spasm, skeletal muscle relaxants.
Buspirone/Buspar. Slower onset of action than Benzo. Give with SSRI if pt clenches. Binds to 5HT, good for chronic anxiety because not dependence.
| Peripherally acting Muscle relaxant | |||
| Medication | Dose range | Labs / monitor | Side effects |
| Botulinum Toxin A |
Masseter 40units/muscl Temporalis 30 units/mucle Pterygoid 15-25 units/muscle |
Temporary facial drooping | |
Comments
Botulinum Toxin A. A peripherally acting muscle relaxant inhibits the release of acetylcholine at neuromuscular junction