Muscle Spasm Medications

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MUSCLE SPASM TREATMENTS
Generic Brand Strength Form Usual Adult Dose
Alpha2-ADRENERGIC AGONIST
tizanidine HCl Zanaflex 4mg scored tabs Usually 4mg, may increase by 2−4mg as needed every 6−8hrs 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.
2mg, 4mg, 6mg caps
ANTICHOLINERGIC MUSCLE RELAXANT (CENTRAL)
orphenadrine
citrate
100mg sust-rel tabs 100mg twice daily in AM and PM
Norflex 60mg/2mL inj1 60mg IM or IV every 12hrs
ANTICHOLINERGIC MUSCLE RELAXANT (CENTRAL) + SALICYLATE
orphenadrine
citrate
25mg tabs 1−2 tabs 3−4 times daily
aspirin 385mg
caffeine 30mg
orphenadrine
citrate
50mg scored tabs ½−1 tab 3−4 times daily; max 4 tabs daily
aspirin 770mg
caffeine 60mg
BENZODIAZEPINE
diazepam CIV 5mg/5mL soln 2−10mg 3−4 times daily. Elderly, debilitated: Initially 2−2.5mg 1−2 times daily; increase gradually.
5mg/mL inj4 Initially 5−10mg slow IV (5mg/min) or IM. May repeat after 3−4hrs.
Tetanus: May need larger dose. Do not use small vein.
Diazepam Intensol CIV 5mg/mL concen-
trated soln2
2−10mg 3−4 times daily Elderly, debilitated: Initially 2−2.5mg 1−2 times daily; increase gradually. Mix with liquid or semi-solid food.
Valium CIV 2mg, 5mg, 10mg scored tabs 2−10mg 3−4 times daily Elderly, debilitated: Initially 2−2.5mg 1−2 times daily; increase gradually.
MUSCLE RELAXANT (CENTRAL)
baclofen 10mg, 20mg scored tabs 5mg 3 times daily; increase in increments of 5mg 3 times daily every 3 days if needed; max 80mg daily
Gablofen 50mcg/mL, 500mcg/
 
mL, 1000mcg/
 
mL, 2000mcg/
 
mL
intra-
thecal inj
See full labeling.
Lioresal 50mcg/mL, 500mcg/
 
mL, 2000mcg/
 
mL
intra-
thecal inj
See full labeling.
carisoprodol Soma CIV 350mg tabs ≥16yrs: 250−350mg 3 times daily and at bedtime; max 2−3wks
<16yrs: Not recommended.
Soma 250 CIV 250mg tabs
chlorzox-
azone
375mg, 750mg+ tabs (+scored) 375mg: 1 tab 3−4 times daily; may increase to 2 tabs (750mg) 3−4 times daily if inadequate response. 750mg: ⅓ tab (250mg) 3−4 times daily. Painful musculoskeletal conditions: initially ⅔ tab (500mg) 3−4 times daily; may increase to 1 tab (750mg) 3−4 times daily if inadequate response. May reduce dose based on improvement.
Parafon Forte DSC 500mg scored caplets 500mg 4 times daily; max 750mg 4 times daily
cyclobenza-
prine HCl
Amrix 15mg, 30mg ext-rel caps 15mg once daily; may increase to 30mg once daily; max 2−3wks. Take at same time each day. Elderly or hepatic impairment: Not recommended.
5mg, 10mg tabs ≥15yrs: Initially 5mg 3 times daily; may increase to 10mg 3 times daily; max 2−3wks. Elderly or hepatic impairment: Initially 5mg, then titrate up.
<15yrs: Not established.
Fexmid 7.5mg tabs ≥15yrs: Initially 5mg 3 times daily; may increase to 7.5mg or 10mg 3 times daily; max 2−3wks. Elderly or hepatic impairment: Consider less frequent dosing.
<15yrs: Not recommended.
metaxalone Skelaxin 800mg scored tabs 800mg 3−4 times daily.
methocar-
bamol
Robaxin 500mg 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 750mg tabs ≥16yrs: Initially 1.5g 4 times daily for 2−3 days; if severe, may give up to 8g/day. Maintenance: 750mg every 4hrs or 1.5g 3 times daily.
<16yrs: Not recommended.
MUSCLE RELAXANT (LOCAL)
dantrolene sodium Dantrium 25mg, 50mg, 100mg 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 200mg tabs 1−2 tabs 4 times daily
aspirin 325mg
MUSCLE RELAXANT (CENTRAL) + SALICYLATE + OPIOID
carisoprodol CIII 200mg tabs1 1−2 tabs 4 times daily
aspirin 325mg
codeine phosphate 16mg
NEUROMUSCULAR BLOCKERS
abobotuli-
numtoxin A
Dysport 300 U/vial, 500 U/vial IM inj3 See full labeling.
incobotuli-
numtoxin A
Xeomin 50 U/vial,
100 U/vial, 200 U/vial
IM inj3 See full labeling.
onabotuli-
numtoxin A
Botox 50 U/vial, 100 U/vial, 200 U/vial IM or intra-
detrusor inj3
See full labeling.
rimabotuli-
numtoxin B
Myobloc 2500 U/
 
0.5mL,
5000 U/
 
1mL, 10000 U/
 
2mL
IM inj3 See full labeling.
NOTES

1contains sulfites; 2contains alcohol 19%; 3contains human albumin; 4contains propylene glycol 40%, ethyl and benzyl alcohol
Not an inclusive list of medications and/or doses. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.

(Rev. 7/2017)

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