Flexeril: Targeted Muscle Spasm Relief for Enhanced Mobility
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Flexeril (cyclobenzaprine hydrochloride) is a centrally acting skeletal muscle relaxant indicated as an adjunct to rest and physical therapy for the relief of muscle spasm associated with acute, painful musculoskeletal conditions. It works by acting primarily within the central nervous system (CNS) at the brainstem level, reducing tonic somatic motor activity. While it does not directly relax skeletal muscles, its efficacy stems from its CNS effects, helping to alleviate discomfort and improve functional range of motion. This medication is intended for short-term use, typically not exceeding two or three weeks, due to insufficient evidence of long-term effectiveness and a concomitant increase in the risk of adverse reactions.
Features
- Active Ingredient: Cyclobenzaprine hydrochloride
- Available Strengths: 5 mg and 7.5 mg oral tablets
- Mechanism of Action: Centrally acting skeletal muscle relaxant; believed to primarily work at the brainstem level
- Onset of Action: Typically within one hour of administration
- Duration of Effect: Provides relief for muscle spasms for several hours per dose
- Prescription Status: Available by prescription only in most jurisdictions
Benefits
- Rapid relief from acute muscle spasms associated with musculoskeletal conditions
- Reduction in local pain and tenderness, facilitating improved mobility
- Adjunctive therapy that enhances the effectiveness of physical therapy and rest
- Helps break the cycle of pain-spasm-pain, promoting faster recovery
- Improves sleep quality by alleviating discomfort that can interfere with rest
- Supports a quicker return to normal daily activities and functional status
Common use
Flexeril is commonly prescribed for the short-term management of muscle spasms resulting from acute musculoskeletal conditions. These often include, but are not limited to, injuries such as strains, sprains, and muscle tears. It is frequently used in cases of acute lower back pain where muscle spasm is a significant component of the patient’s discomfort. Clinicians may also prescribe it post-operatively in certain orthopedic surgeries where muscle spasm impedes recovery. It is important to note that Flexeril is not indicated for the treatment of spasticity associated with cerebral or spinal cord diseases, or in children. Its use is specifically targeted toward otherwise healthy individuals experiencing an acute, painful episode.
Dosage and direction
The recommended dosage of Flexeril for most adults is 5 mg taken three times daily. Based on individual patient response and tolerability, the dosage may be increased to 7.5 mg or 10 mg three times daily; however, use of the 10 mg dosage is less common and should be carefully considered due to an increased incidence of adverse effects.
The tablets should be taken orally, with or without food. Administration with food may help mitigate potential gastrointestinal upset. Because Flexeril can cause drowsiness, patients are advised to consider the timing of their doses, especially if activities requiring mental alertness, such as driving or operating machinery, are anticipated.
The duration of therapy should not exceed two or three weeks. There is inadequate evidence of effectiveness and a concerning risk/profile ratio for longer-term use. Dosage adjustments are typically not required for elderly patients, but greater sensitivity in some older individuals cannot be ruled out. The safety and effectiveness of Flexeril in pediatric patients below the age of 15 have not been established.
Precautions
Patients should be advised that Flexeril may impair mental and/or physical abilities required for the performance of hazardous tasks, such as operating machinery or driving a motor vehicle. This effect can be potentiated by alcohol and other CNS depressants.
Due to its atropine-like action, Flexeril should be used with caution in patients with a history of urinary retention, angle-closure glaucoma, increased intraocular pressure, and in patients taking anticholinergic medications. It may also raise heart rate and should be used cautiously in individuals with tachycardia.
Flexeril is closely related to the tricyclic antidepressants (TCAs). It should be used with extreme caution in patients with a history of cardiovascular disease, including arrhythmias, conduction disturbances, myocardial infarction, and congestive heart failure. Hyperpyrexia and severe seizures have been reported in patients receiving cyclobenzaprine concomitantly with other serotonergic drugs, highlighting the risk of serotonin syndrome.
Contraindications
Flexeril is contraindicated in patients who are hypersensitive to any component of this product. Its use is also contraindicated in the following scenarios:
- Concomitant use of monoamine oxidase (MAO) inhibitors or within 14 days after their discontinuation. Hyperpyretic crisis, severe convulsions, and deaths have occurred in patients receiving TCAs and MAO inhibitors simultaneously.
- During the acute recovery phase of myocardial infarction.
- In patients with arrhythmias, heart block or conduction disturbances, or congestive heart failure.
- In patients with hyperthyroidism.
Possible side effect
The most common adverse reactions are drowsiness, dry mouth, and dizziness. Their incidence is dose-related.
Common (≥1% and <10%):
- Drowsiness
- Dry mouth
- Dizziness
- Fatigue
- Asthenia (weakness)
- Nausea
- Constipation
- Dyspepsia
- Unpleasant taste
- Blurred vision
- Headache
Less Common (<1% but >0.1%):
- Nervousness
- Confusion
- Tachycardia (increased heart rate)
- Tremor
- Insomnia
- Sweating
- Skin rash
- Abdominal pain
- Diarrhea
- Vasodilation (flushing)
- Palpitations
- Paresthesia (tingling/numbness)
- Myalgia (muscle pain)
Rare:
- Serotonin syndrome (especially when combined with other serotonergic drugs)
- Allergic reactions, including anaphylaxis
- Hepatitis
- Jaundice
- Seizures
- Neuroleptic malignant syndrome (NMS)
Drug interaction
Flexeril has the potential to interact with several other classes of medication, primarily due to its structural similarity to TCAs and its CNS effects.
- Monoamine Oxidase Inhibitors (MAOIs): Contraindicated. Risk of hyperpyretic crisis, severe convulsions, and death.
- CNS Depressants: Additive sedative effects with alcohol, benzodiazepines, opioids, other skeletal muscle relaxants, and sedating antihistamines. Use with extreme caution.
- Anticholinergic Agents: Additive anticholinergic effects (e.g., dry mouth, urinary retention, constipation) when used with other drugs possessing anticholinergic properties.
- Tramadol: May enhance the risk of seizures.
- Serotonergic Drugs: Concomitant use with SSRIs, SNRIs, triptans, certain opioids (e.g., fentanyl), and other drugs that affect serotonin can increase the risk of serotonin syndrome.
- Guanethidine and Similar Agents: Cyclobenzaprine may block the antihypertensive effect of guanethidine and similarly acting compounds.
- Sympathomimetics: Cyclobenzaprine may enhance the effects of epinephrine, norepinephrine, and other sympathomimetic drugs, potentially leading to cardiovascular effects.
Missed dose
If a dose is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed one, as this increases the risk of adverse effects.
Overdose
Overdose of Flexeril may be life-threatening and often involves signs of severe CNS depression, anticholinergic effects, and cardiovascular toxicity.
Symptoms may include:
- Severe drowsiness, agitation, restlessness, confusion, hallucinations
- Tachycardia, cardiac arrhythmias, hypertension or hypotension
- Hyperthermia
- Dilated pupils
- Dry, hot skin
- Reduced gastrointestinal motility (ileus)
- Convulsions
- Coma
- Cardiac arrest
Management: There is no specific antidote for cyclobenzaprine overdose. Management is symptomatic and supportive. This includes securing the airway, ensuring adequate ventilation, and monitoring cardiac function and vital signs. Gastric lavage may be considered if performed early. Activated charcoal can be administered. For severe anticholinergic effects with CNS excitement, physostigmine may be considered but is not without risk. Treatment of seizures with benzodiazepines may be necessary. Intensive supportive care is paramount.
Storage
Flexeril tablets should be stored at controlled room temperature, 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F). The medication must be kept in its original container, tightly closed, and out of reach of children and pets. It should be protected from light, moisture, and excessive heat. Unused or expired medication should be disposed of properly according to local guidelines, preferably via a drug take-back program, and should not be flushed down the toilet or thrown in the trash.
Disclaimer
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided is based on the manufacturer’s prescribing information but may not be exhaustive. Individual patient response to medication can vary.
Reviews
Clinical studies and post-marketing surveillance provide the most reliable aggregate data on efficacy and tolerability. In controlled clinical studies, Flexeril 5 mg and 10 mg demonstrated significant improvement in relieving muscle spasm, local pain, and tenderness, and in increasing range of motion, compared to placebo. The 5 mg dose was associated with a markedly lower incidence of drowsiness (29% vs. 38% for the 10 mg dose and 10% for placebo) and dry mouth (21% vs. 32% for the 10 mg dose and 7% for placebo). Patient-reported outcomes often highlight its effectiveness in breaking the acute pain cycle, though the side effect of drowsiness is frequently noted. It is generally regarded by clinicians as a valuable short-term adjunctive therapy for appropriate patients.