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Muscle relaxers are prescription medications that can help treat symptoms like spasticity and muscle spasms. They are also used to treat acute lower back pain and muscle spasms caused by injuries or problems that cause muscle or joint pain. Muscle relaxers can cause mild to moderate sedation, impacting daily activities like driving. They can also cause dizziness, blurred vision, and fainting. Older adults are at a higher risk for side effects such as sedation, confusion, and memory problems. Prolonged use can lead to physical dependence, and certain muscle relaxers can cause liver damage. Cyclobenzaprine (Flexeril) is one of the most commonly prescribed muscle relaxers, with 28.4 million prescriptions dispensed in the United States in 2017. It is used to treat muscle spasms and relieve pain, stiffness, and discomfort caused by strains, sprains, or injuries. While it is an effective treatment, it can cause side effects such as drowsiness, dizziness, blurred vision, and dry mouth. It can also cause more severe side effects such as serotonin syndrome and abnormal heart rhythm.
| Characteristics | Values |
|---|---|
| Muscle relaxers | Carisoprodol (Soma), Cyclobenzaprine (Flexeril), Baclofen (Lioresal), Dantrolene (Dantrium, Revonto, Ryanodex), Tizanidine (Zanaflex), Diazepam (Valium) |
| Side effects | Dizziness, sedation, blurred vision, fainting, dry mouth, confusion, urinary retention, memory problems, liver damage, nausea, headache, fatigue, abnormal heart rhythm, withdrawal symptoms, and more |
| Risk factors | Combining with alcohol or other drugs, long-term use, high doses, age (older adults and pregnant/lactating women), combining with multiple medications |
| Addiction potential | Yes, especially with Soma |
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What You'll Learn
Muscle relaxers and their side effects
Muscle relaxers are prescription medications that can help treat symptoms like spasticity and muscle spasms. They can also be used to treat acute lower back pain and acute muscle pain. The two types of antispasmodics are benzodiazepines and nonbenzodiazepines. Benzodiazepines block certain chemicals in the brain, and nonbenzodiazepines act on both the brain and spinal cord. Muscle relaxers can be addictive and can cause adverse side effects.
Muscle relaxers can cause mild to moderate sedation, impacting daily activities like driving. They can also cause dizziness, blurred vision, fainting, and urinary incontinence. The use of muscle relaxers in older adults carries a higher risk of side effects, such as sedation, confusion, urinary retention, or memory problems. This is due to the body's decreased ability to process and clear medications as age increases. Older adults are also more likely to have impaired liver or kidney function, which can enhance the sedating side effects of muscle relaxers.
Some muscle relaxers can cause liver damage, ranging from increased liver enzymes to severe liver toxicity. It is important to be cautious when combining muscle relaxers with other substances or medications. Using muscle relaxers with alcohol or cannabis can increase the risk of sedation and impairment. Combining muscle relaxers with opioid medications should be avoided due to the increased risk of central nervous system depression.
Prolonged use of muscle relaxers can lead to increased tolerance and physical dependence. Muscle relaxers are intended as a short-term treatment, typically prescribed for less than two to three weeks. Abruptly stopping certain muscle relaxers can result in withdrawal symptoms, especially with long-term use or high doses. It is recommended to gradually taper off the medication under the supervision of a doctor to prevent withdrawal symptoms.
Commonly prescribed muscle relaxers include carisoprodol (Soma), cyclobenzaprine (Flexeril), baclofen (Lioresal), dantrolene (Dantrium, Revonto, or Ryanodex), tizanidine (Zanaflex), and diazepam (Valium). It is important to consult a doctor or pharmacist before taking any muscle relaxers and to follow the instructions closely.
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Combining muscle relaxers with other substances
For example, using muscle relaxers with alcohol or cannabis can increase the risk of sedation and impairment. Alcohol is a central nervous system depressant, and combining it with muscle relaxers can enhance their sedating effects. Similarly, cannabis contains tetrahydrocannabinol (THC), which may have muscle relaxant properties. However, there is limited research on the effects of cannabis due to its prohibition in many places.
Older adults are more susceptible to the adverse effects of combining muscle relaxers with other substances. This is because their bodies may have impaired liver or kidney function, which can amplify the sedating side effects of muscle relaxers. Additionally, older adults often take multiple medications and supplements, increasing the risk of dangerous drug interactions.
Muscle relaxers should also be used with caution when combined with opioid medications such as oxycodone or morphine. Combining these substances does not improve pain relief and may lead to central nervous system depression. Furthermore, muscle relaxers should not be taken with other medicines that cause dizziness and sleepiness, such as prescription pain medicines, sleep medicines, and medicines for anxiety. Combining muscle relaxers with these substances can increase the risk of side effects such as dizziness, drowsiness, and blurred vision.
It is important to consult a doctor or pharmacist before taking muscle relaxers, especially when combining them with other substances. They can provide specific instructions on how to take the medication safely and advise on potential drug interactions. Additionally, muscle relaxers are intended for short-term use, typically prescribed for less than two to three weeks, to minimise the risk of tolerance and physical dependence.
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Muscle relaxers for older adults
Muscle relaxers are prescription medications used to treat acute muscle pain and discomfort caused by muscle spasms. They are also used to treat spasticity, a disruption in muscle movement patterns that causes certain muscles to contract simultaneously at rest or when trying to move.
The use of muscle relaxers in older adults carries a higher risk of side effects, including sedation, confusion, urinary retention, and memory problems. This is due to the body's reduced ability to process and clear medications as we age, as well as the potential for impaired liver or kidney function, which can enhance the sedating side effects of muscle relaxers. Older adults are also more likely to be taking multiple medications, increasing the risk of dangerous drug interactions.
Some muscle relaxants, such as carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, and orphenadrine, are generally avoided in older adults due to the risk of sedation and falls. However, other muscle relaxants, such as tizanidine, baclofen, and dantrolene, may be helpful for neck and back pain in older adults when used in reduced doses. It is important to avoid tizanidine with liver disease and reduce baclofen dosing for those with kidney disease.
Non-pharmacologic therapies, such as massage therapy, strength training, and superficial heat, may be preferred alternatives for older adults before prescribing muscle relaxers. If pharmacologic therapy is deemed necessary, ibuprofen may be a better option than skeletal muscle relaxants for patients without heart failure, renal dysfunction, or a history of gastrointestinal issues.
It is crucial for older adults to consult with their doctors and discuss the potential risks and benefits of muscle relaxers, considering their medical history and other medications they may be taking.
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Muscle relaxers and addiction
Muscle relaxers are prescription medications used to treat muscle spasms and pain. They are typically prescribed when other treatments, such as over-the-counter medications, have failed to alleviate the pain. While muscle relaxers can be effective, they also carry a risk of addiction and misuse.
The potential for addiction varies across different types of muscle relaxers. Carisoprodol (Soma), for instance, is considered a Schedule IV controlled substance due to its high risk of addiction and abuse. It is one of the most commonly diverted drugs in the United States, with users taking it without a prescription or in larger amounts than prescribed. Diazepam (Valium) is another muscle relaxer with a high addiction potential, and it is also classified as a Schedule IV controlled substance. Other muscle relaxers with lower but still significant addiction potential include Cyclobenzaprine (Flexeril) and Tizanidine (Zanaflex).
The risk of addiction to muscle relaxers is heightened when they are taken beyond the prescribed dosage or duration. Additionally, prolonged use can lead to physical dependence, resulting in withdrawal symptoms upon cessation. This is especially true for Soma, which has a short half-life, causing users to develop tolerance and dependence more quickly. As a result, muscle relaxers are typically prescribed for short periods, usually not exceeding 2-3 weeks.
Certain individuals are more susceptible to developing an addiction to muscle relaxers. People with a personal or family history of substance use disorders are at a higher risk. Additionally, older adults are more prone to experiencing amplified side effects and adverse drug interactions, making them more vulnerable to addiction and misuse.
The misuse of muscle relaxers can have severe consequences, including an increased risk of overdose, which can lead to changes in consciousness, hallucinations, respiratory depression, and even cardiac arrest. Therefore, it is crucial to follow the prescribed dosage and duration and to be vigilant for signs of addiction in oneself or loved ones.
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Types of muscle relaxers
Muscle relaxers are prescription medications that help regulate muscle contraction (tightening) to reduce pain and discomfort caused by muscle spasms and muscle spasticity (stiffness). They are categorised based on their ability to treat stiffness, spasms, or both. The different types of muscle relaxers include:
Antispastic Drugs
Antispastic drugs reduce muscle tightness by acting on the spinal cord or skeletal muscle directly. They are effective in treating spasticity, but high doses can lead to unwanted side effects. Antispastic drugs include:
- Baclofen (Lioresal): Used to relieve spasticity caused by multiple sclerosis (MS).
- Tizanidine (Zanaflex): Has both antispastic and antispasmodic effects.
- Dantrolene (Dantrium): Used to treat muscle spasms caused by spinal cord injury, stroke, cerebral palsy, or MS.
Antispasmodic Drugs
Antispasmodic drugs are more frequently prescribed for back and neck pain compared to antispastics. They decrease muscle spasms by acting on the central nervous system (brain and spinal cord). Antispasmodics include:
- Tizanidine: Has both antispastic and antispasmodic activity.
- Diazepam (Valium): Has both antispastic and antispasmodic effects and is also used to treat anxiety and seizures.
- Cyclobenzaprine: Found to be moderately more effective than a placebo in treating fibromyalgia.
Benzodiazepines
Benzodiazepines are a class of medications that include:
Diazepam (Valium): A sedative that helps relieve muscle spasms caused by inflammation, trauma, or muscle spasticity.
Non-Benzodiazepine Muscle Relaxers
Non-benzodiazepine muscle relaxers include:
Carisoprodol: A controlled substance with addiction potential and can cause withdrawal symptoms.
It is important to note that muscle relaxers are typically prescribed for short-term use (2-3 weeks) due to the potential for adverse side effects and addiction. Oral muscle relaxers in the form of tablets or capsules are more commonly prescribed due to their convenience, while injections are used in emergency care or when a person has difficulty swallowing.
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Frequently asked questions
Muscle relaxers are prescription medications that can help treat symptoms like spasticity and muscle spasms. They are also used to treat acute lower back pain and acute muscle pain.
Muscle relaxers can cause mild to moderate sedation, dizziness, blurred vision, fainting, and urinary incontinence. They can also cause serious side effects like serotonin syndrome, which can be life-threatening.
Yes, muscle relaxers such as cyclobenzaprine (Flexeril) can cause headaches, especially when stopping usage after prolonged use.
Muscle relaxers can cause physical and psychological addiction or dependence. They can also cause liver damage and increase the risk of sedation and impairment when used with alcohol or cannabis. Older adults are also at a higher risk of experiencing side effects.
Muscle relaxers work by acting as central nervous system depressants, causing a sedative effect and preventing nerves from sending pain signals to the brain.
