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. Diazepam diazepam tablet [package insert]. Miami, Fla. Skelaxin metaxalone [package insert]. Briston, Tenn. Methocarbamol methocarbamol tablet [package insert]. January 14, Orphenadrine citrate extended-release orphenadrine citrate tablet [package insert]. Princeton, NJ: Sandoz, Inc. Tizanidine hydrochloride tizanidine hydrochloride tablet [package insert]. Pomona, NY: Barr Laboratories.
United States Food and Drug Administration. Zanaflex tizanidine hydrochloride tablets and capsules. Top brand-name drugs by units in Top generic drugs by units in Flexeril is also structurally similar to tricyclic antidepressants and has similar side effects such as dry mouth and sedation.
Flexeril is commonly known by its generic name cyclobenzaprine. Brand-name Flexeril has been discontinued; however, cyclobenzaprine is available in two other brand names: Amrix extended-release and Fexmid immediate-release. The extended-release tablet can be taken once per day. Sign up for Robaxin price alerts and find out when the price changes!
Get price alerts. Robaxin and Flexeril are FDA approved to treat discomfort or muscle spasms from acute musculoskeletal conditions as well as tetanus. Robaxin or Flexeril are usually prescribed to treat musculoskeletal pain such as neck pain. Both drugs are also often used to treat low back pain, a common problem in adults in the US.
Flexeril has also been studied to treat fibromyalgia, a chronic condition characterized by muscle pain all over the body. Those with fibromyalgia may experience widespread muscle pain as well as problems with sleep, fatigue, and mood. According to a meta-analysis of five clinical trials, cyclobenzaprine was found to improve sleep and pain in patients with fibromyalgia over a period of up to 24 weeks.
Robaxin and Flexeril are effective treatments for treating musculoskeletal pain and muscle spasms. The more effective drug is the one that works best for your specific case. Flexeril is one of the most studied muscle relaxants; thus, it has more supporting evidence for its effectiveness.
In a systematic review , it was found that, in general, muscle relaxants are comparable in effectiveness. This review included other muscle relaxants such as metaxalone, baclofen, tizanidine, orphenadrine, and chlorzoxazone.
In a head-to-head trial between methocarbamol and cyclobenzaprine, there was no significant difference in muscle spasms or tenderness. Cyclobenzaprine has been compared to Valium diazepam and Soma carisoprodol in clinical trials. Cyclobenzaprine was similarly effective to these drugs for treating acute low back pain.
Consult a healthcare provider for medical advice to find the best treatment options for you. After a complete assessment from a doctor, one drug may be preferred depending on your overall medical history. Generic Robaxin tablets are usually covered by Medicare and insurance plans.
Get the SingleCare prescription discount card. Generic cyclobenzaprine tablets are often covered by Medicare and insurance plans. Even if you do have insurance, it may be a good idea to find out if you can get a cheaper price on muscle relaxants. The most common side effects of Robaxin and Flexeril are drowsiness, dizziness, and headache.
There is fair evidence that baclofen and tizanidine are roughly equivalent for efficacy in patients with spasticity, but insufficient evidence to determine the efficacy of dantrolene compared to baclofen or tizanidine.
There is fair evidence that although the overall rate of adverse effects between tizanidine and baclofen is similar, tizanidine is associated with more dry mouth and baclofen with more weakness.
There is fair evidence that cyclobenzaprine, carisoprodol, orphenadrine, and tizanidine are effective compared to placebo in patients with musculoskeletal conditions primarily acute back or neck pain. Cyclobenzaprine has been evaluated in the most clinical trials and has consistently been found to be effective. There is very limited or inconsistent data regarding the effectiveness of metaxalone, methocarbamol, chlorzoxazone, baclofen, or dantrolene compared to placebo in patients with musculoskeletal conditions.
Consider this guide your roadmap to the top muscle relaxers on the market. In general, pain relief treatments fall into one of three categories: over-the-counter OTC , prescription, and natural. Determining the best muscle relaxer depends entirely on your specific condition and pain level. When in doubt, consult your healthcare provider. Over-the-counter remedies: OTC pain relievers are often the first line of defense against pain, inflammation, and tension. They can work wonders for milder conditions like neck and lower back pain.
Because of their more serious side effects, prescription muscle relaxers are designed for short-term use, after which your doctor will transition to other drugs or treatments. Natural remedies: For minor soreness and stress-related symptoms, the only treatment you need might be drawn straight from nature. Before rushing off to the doctor for an examination and potential prescription, you might be able to administer an effective plant-based therapy right from home.
These are the medications that you can find while perusing the aisles at your local pharmacy or convenience store. If you roll your ankle at the gym or wake up with back pain, try one of these before asking your doctor for a prescription.
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