Muscle Spasm Treatments

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.
tizanidine HCl	Zanaflex	℞	2mg, 4mg, 6mg	caps
ANTICHOLINERGIC MUSCLE RELAXANT (CENTRAL)
orphenadrine citrate	—	℞	100mg	sust-rel tabs	100mg twice daily in AM and PM
orphenadrine citrate	—	℞	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.
	—	CIV	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.
carisoprodol	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.
chlorzox– azone	—	℞	500mg	scored caplets	500mg 4 times daily; max 750mg 4 times daily
cyclobenza– prine HCl	—	℞	5mg, 10mg, 7.5mg	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.
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.
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.
methocar– bamol	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	tabs	1−2 tabs 4 times daily
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. 6/2018)

Muscle Spasm Treatments

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