What is Zanaflex?
Zanaflex (tizanidine) is a short-acting muscle relaxer. It works by blocking nerve impulses (pain sensations) that are sent to your brain.
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Carisoprodol, sold under the brand name Soma among others, is a medication used for musculoskeletal pain. Use is only approved for up to three weeks. Effects generally begin within half an hour and last for up to six hours. It is taken by mouth.
Tizanidine is used to relieve the spasms and increased muscle tone caused by multiple sclerosis (MS, a disease in which the nerves do not function properly and patients may experience weakness, numbness, loss of muscle coordination and problems with vision, speech, and bladder control), stroke, or brain or spinal injury. Tizanidine is in a class of medications called skeletal muscle relaxants. It works by slowing action in the brain and nervous system to allow the muscles to relax.
How should Zanaflex be used?
Tizanidine comes as a tablet and a capsule to take by mouth. It is usually taken consistently either always with or always without food two or three times a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take tizanidine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Tizanidine capsules may be opened and sprinkled on soft foods such as applesauce. Talk to your doctor before opening the capsules because the effects of the medication when used in this manner may be different than when swallowing the capsule whole.
The medication in the capsule is absorbed differently by the body than the medication in the tablet, so one product cannot be substituted for the other. Each time you have your prescription filled, look at the tablets or capsules in the bottle and make sure that you have received the right product. If you think you received the wrong medication, talk to your doctor or pharmacist right away.
Your doctor will probably start you on a low dose of tizanidine and gradually increase your dose, depending on your response to this medication.
Do not stop taking tizanidine without talking to your doctor. If you suddenly stop taking tizanidine, your heart may beat faster and you may have increased blood pressure or tightness in your muscles. Your doctor will probably decrease your dose gradually.
Other uses for Zanaflex
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
What special precautions should I follow?
Before taking tizanidine,
- tell your doctor and pharmacist if you are allergic to tizanidine or any other medications.
- tell your doctor if you are taking ciprofloxacin (Cipro) or fluvoxamine. Your doctor will probably tell you not to take tizanidine if you are taking either of these medications.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: acyclovir (Zovirax); amiodarone (Cordarone, Pacerone); baclofen; cimetidine (Tagamet); clonidine (Catapres, Catapres-TTS); dantrolene (Dantrium); diazepam (Valium); famotidine (Pepcid, Pepcid AC); medications for anxiety, seizures, or high blood pressure; mexiletine (Mexitil); oral contraceptives (birth control pills); propafenone (Rythmol); fluoroquinolones such as gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxacin (Avelox), norfloxacin (Noroxin), and ofloxacin (Floxin); ticlopidine (Ticlid); sedatives; sleeping pills; tranquilizers; verapamil (Calan, Covera, Isoptin, Verelan); and zileuton (Zyflo). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Other medications may also interact with tizanidine, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
- tell your doctor if you have or have ever had kidney or liver disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking tizanidine, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking tizanidine.
- you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
- remember that alcohol can add to the drowsiness caused by this medication.
- you should know that tizanidine may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking tizanidine. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.tizanidine can decrease muscle tone, so be careful when walking or doing other activities where you rely on your muscle tone to help with your posture or balance.
What special dietary instructions should I follow?
Unless your doctor tells you otherwise, continue your normal diet.
What should I do if I forget a dose?
If your doctor has told you to take tizanidine regularly, take the missed dose as soon as you remember it. However, if it is almost time for your 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.
What side effects can Zanaflex cause?
Tizanidine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- tingling sensation in the arms, legs, hands, and feet
- dry mouth
- stomach pain
- increased muscle spasms
- back pain
Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:
- extreme tiredness
- unusual bleeding or bruising
- lack of energy
- loss of appetite
- pain in the upper right part of the stomach
- yellowing of the skin or eyes
- unexplained flu-like symptoms
- seeing things or hearing voices that do not exist
- slow heartbeat
- changes in vision
Tizanidine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).
What should I know about storage and disposal of this medication?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org
Usual Adult Dose for Muscle Spasm:
-Initial dose: 2 mg orally every 6 to 8 hours as needed
-The dose of Zanaflex can be increased by your doctor if needed
-The medication effects peak in about 1 to 2 hours and last for 3 to 6 hours
-Do not take more than 16mg of Zanaflex at one time. Do not take more than 36mg in 24 hours.
-The capsules and tablets are absorbed differently by the body. Do not switch from one to the other without talking to your doctor.
-Zanaflex should be taken with food every time or without food every time. Do not switch back and forth.
In case of emergency/overdose
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.
Symptoms of overdose may include:
- extreme tiredness
- slow heartbeat
- slow or shallow breathing
- loss of consciousness
What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to tizanidine.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Last Revised – 11/15/2015
What other drugs will affect Zanaflex?
Taking Zanaflex with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before taking a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures.
Tell your doctor about all your current medicines and any you start or stop using, especially:
- birth control pills;
- an antibiotic, including ciprofloxacin, gemifloxacin, levofloxacin, moxifloxacin, ofloxacin, or others;
- blood pressure medicine such as clonidine, guanfacine, methyldopa;
- heart rhythm medicine including amiodarone, mexiletine, propafenone, verapamil; or
- stomach acid medicine such as cimetidine, famotidine.
This list is not complete. Other drugs may interact with tizanidine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
Tizanidine Pregnancy Warnings
US FDA pregnancy category: C
Teratogenicity was not shown in animal studies in rats and rabbits. At doses up to 8 times the maximum recommended human dose, increased gestation duration was observed in rats. Pre and prenatal and postnatal pup loss and developmental retardation occurred in rats and rabbits and post-implantation loss was increased in rabbits at doses of 1 mg/kg or more. There are no controlled studies in pregnant women.
US FDA pregnancy category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Tizanidine Breastfeeding Warnings
Safety has not been established
Excreted into human milk: Unknown
Excreted into animal milk: Yes
Comments: If used, monitor infant for toxicity such as sedation, hypotension, and hallucinations.As a lipid soluble drug, it might be expected to pass into breast milk.
How it works
- Tizanidine relaxes muscles by dampening down nerve impulses that are sent from spasming muscles along nerve fibers to the brain.
- Tizanidine belongs to the class of medicines known as central alpha-2-adrenergic agonists. It also belongs to the group of medicines known as muscle relaxants.
- Effective at relaxing muscles (reduces muscles spasms).
- May be used on an as-needed basis.
- Generic tizanidine is available.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- Low blood pressure, drowsiness, dizziness, energy loss, and a dry mouth.
- Has been associated with hallucinations and rarely psychosis in approximately 3% of people.
- May not be suitable for people that rely on spasticity to sustain their posture and balance.
- May cause a drop in blood pressure when going from a sitting or lying down position to standing. This may increase the risk of falls.
- May affect a person’s ability to drive or operate machinery. Alcohol should be avoided.
- May cause withdrawal symptoms such as high blood pressure and a fast heartbeat if stopped abruptly after regular extended dosing (decrease dose slowly under a doctor’s advice).
- Not recommended to be taken by people with liver or kidney disease.
- Seniors may be more susceptible to the side effects of tizanidine.
- May interact with a number of other drugs including those metabolized by hepatic enzymes CYP1A2 (such as fluvoxamine, ciprofloxacin, some antiarrhythmics), and oral contraceptives. Alcohol increases the peak concentration of tizanidine and also the likelihood of side effects.
- Liver enzymes (specifically aminotransferase) should be monitored when starting treatment and for at least one month after the maximum dosage is achieved.
Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects.
- Capsules may be opened and the contents sprinkled on food.
- Taking with food increases absorption by 20% but slows time for effect. Can be taken with or without food, but should be dosed consistently (either with or without food).
- Take tizanidine exactly as directed. Do not increase the dosage without your doctor’s advice. Tizanidine tablets and capsules are not directly interchangeable; a dosage adjustment may be necessary (talk with your doctor).
- Be careful when going from sitting or lying down position to standing as tizanidine may increase your risk of falls. Remove any fall hazards (such as loose rugs) from your home.
- Seek immediate medical advice if you experience any worrying side effects including hallucinations or allergic-type reactions.
- Do not stop taking tizanidine suddenly without your doctor’s advice as high blood pressure and a fast heartbeat may result.
- Effects are dose-related (the bigger the dose, the stronger the effect, but the more noticeable any side effects are).
- Do not drink any alcohol while taking tizanidine.
- Do not take any other medication, including medicines brought over-the-counter, in addition to tizanidine, without first checking with your doctor or pharmacist first to make sure they are compatible.
Response and Effectiveness
The effects of tizanidine peak within 1-2 hours and start to wear off within 3 to 6 hours. Because of this short duration of effect, tizanidine may be dosed on an “as needed” basis during times when muscle spasms are at their most severe.
Note that this list is not all-inclusive and includes only common medications that may interact with tizanidine. You should refer to the prescribing information for tizanidine for a complete list of interactions.