Muscle Spasms
| MUSCLE SPASMS† | |||||
|---|---|---|---|---|---|
| Generic & Class | Brand & Company | Strength | Formulations‡ | Usual Adult Dose | |
| α2-ADRENERGIC AGONIST | |||||
| Tizanidine HCl | ZANAFLEX TABLETS
(Acorda Therapeutics) |
4mg | Rx | scored tabs | Initially: usually 4mg, may increase by 2–4mg as needed every 6–8 hrs
to a max of 3 doses in 24hrs; max 12mg/dose and 36mg/day. Renal impairment (CrCl <25mL/min): reduce dose.
May sprinkle contents of capsules on applesauce (may affect absorption). Tabs and caps not bioequivalent under fed conditions. |
| ZANAFLEX CAPSULES
(Acorda Therapeutics) |
2mg, 4mg, 6mg | Rx | caps | ||
| ANTICHOLINERGIC MUSCLE RELAXANT (CENTRAL) | |||||
| Orphenadrine citrate | (various) | 100mg | Rx | sust-rel tabs | 100mg twice daily (AM and PM). |
| NORFLEX INJECTION
(Medicis Pharmaceuticals Corp) |
60mg/2mL | Rx | inj* | 60mg IM or IV every 12 hrs. | |
| ANTICHOLINERGIC MUSCLE RELAXANT (CENTRAL) + SALICYLATE | |||||
| Orphenadrine citrate | (various) | 25mg | Rx | tabs | 1–2 tabs 3–4 times daily. |
| Aspirin | 385mg | ||||
| Caffeine | 30mg | ||||
| Orphenadrine citrate | (various) | 50mg | Rx | scored tabs | ½–1 tab 3–4 times daily; max 4 tabs daily. |
| Aspirin | 770mg | ||||
| Caffeine | 60mg | ||||
| BENZODIAZEPINE | |||||
| Diazepam | DIAZEPAM ORAL SOLUTION
(Roxane) |
5mg/5mL | CIV | soln | 2–10mg 3–4 times daily.
Elderly, debilitated: initially 2–2.5mg 1–2 times daily; increase gradually. |
| Diazepam injection
(various) |
5mg/mL | CIV | injΔ | Initially 5–10mg slow IV (5mg/min) or IM. May repeat after 3–4 hours.
Tetanus: may need larger dose. Do not use small vein. |
|
| DIAZEPAM INTENSOL
(Roxane) |
5mg/mL | CIV | concentrated soln** | 2–10mg 3–4 times daily.
Elderly, debilitated: initially 2–2.5mg 1–2 times daily; increase gradually. Intensol: mix with liquid or semi-solid food. |
|
| VALIUM
(Roche) |
2mg, 5mg, 10mg | CIV | scored tabs | 2–10mg 3–4 times daily.
Elderly, debilitated: initially 2–2.5mg 1–2 times daily; increase gradually. |
|
| MUSCLE RELAXANT (CENTRAL) | |||||
| Cyclobenzaprine HCl | AMRIX
(Cephalon) |
15mg, 30mg | Rx | ext-rel caps | Take at same time each day. 15mg once daily; may increase to 30mg/day given once daily. Max 2–3 weeks. |
| Baclofen | (various) | 10mg, 20mg | Rx | scored tabs | 5mg 3 times daily. Increase in increments of 5mg 3 times daily every 3 days if needed; max 80mg daily. |
| Cyclobenzaprine HCl | FEXMID
(Shionogi) |
7.5mg | Rx | tabs | ≥15yrs: initially 5mg 3 times daily; may increase to 7.5mg or 10mg 3
times daily. Max 2–3 weeks.
<15yrs: not recommended. |
| (various) | 5mg, 10mg | Rx | tabs | ≥15yrs: initially 5mg 3 times daily; may increase to 10mg 3 times daily.
Max 2–3 weeks.
<15yrs: not recommended. |
|
| Baclofen | GABLOFEN
(CNS Therapeutics) |
50mcg/mL, 500mcg/mL, 2000mcg/mL | Rx | intrathecal inj | See literature. |
| Chlorzoxazone | PARAFON FORTE DSC
(Janssen) |
500mg | Rx | scored caplets | 500mg 4 times daily; max 750mg 4 times daily. |
| Methocarbamol | ROBAXIN
(Actient) |
500mg | Rx | tabs | ≥16yrs: initially 1.5g 4 times daily for 2–3 days; if severe,
may give up to 8g/day.
Maintenance: 1g 4 times daily <16yrs: not recommended. |
| ROBAXIN-750
(Actient) |
750mg | Rx | tabs | ≥16yrs: initially 1.5g 4 times daily for 2–3 days; if severe,
may give up to 8g/day.
Maintenance: 750mg every 4 hours or 1.5g 3 times daily. <16yrs: not recommended. |
|
| Metaxalone | SKELAXIN
(King) |
800mg | Rx | scored tabs | 800mg 3–4 times daily.
≤12yrs: not recommended. |
| Carisoprodol | SOMA
(Meda) |
350mg | CIV | tabs | ≥16yrs: 250mg–350mg 3 times daily and at bedtime.
Max 2–3 weeks. <16yrs: not recommended. |
| SOMA 250
(Meda) |
250mg | CIV | tabs | ||
| MUSCLE RELAXANT (LOCAL) | |||||
| Dantrolene sodium | DANTRIUM
(Proctor & Gamble) |
25mg, 50mg, 100mg | Rx | caps | 25mg once daily for 7 days, then 25mg 3 times daily for 7 days, then 50mg 3 times daily for 7 days, then 100mg 3 times daily; max 100mg 4 times daily. |
| MUSCLE RELAXANT (CENTRAL) + SALICYLATE | |||||
| Carisoprodol | (various) | 200mg | Rx | tabs | 1–2 tabs 4 times daily. |
| Aspirin | 325mg | ||||
| MUSCLE RELAXANT (CENTRAL) + SALICYLATE + OPIOID | |||||
| Carisoprodol | (various) | 200mg | CIII | tabs* | 1–2 tabs 4 times daily. |
| Aspirin | 325mg | ||||
| Codeine phosphate | 16mg | ||||
| NEUROMUSCULAR BLOCKERS | |||||
| Onabotulinumtoxin A | BOTOX
(Allergan) |
50units/vial, 100units/vial, 200units/vial | Rx | intradetrusor inj*** | See literature. |
| Rimabotulinumtoxin B | MYOBLOC
(Solstice Neurosciences) |
2500 Units/0.5mL, 5000 Units/1mL, 10000 Units/2mL | Rx | IM inj*** | See literature. |
| IncobotulinumtoxinA | XEOMIN
(Merz Pharmaceuticals) |
50 Units/vial, 100 Units/vial | Rx | IM inj*** | See literature. |
| NOTES | |||||
|
‡caps = capsules; tabs = tablets; ext-rel
= extended-release; inj = injection; soln = solution; sust-rel = sustained-release
(Rev. 4/2013) |
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