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Skeletal Muscle Relaxant
Aka: Skeletal Muscle Relaxant, Methocarbamol, Robaxin, Chlorzoxazone, Parafon Forte, Metaxalone, Skelaxin, Orphenadrine, Norflex, Tizanidine, Zanaflex, Carisoprodol, Soma- See Also
- Antispastic Muscle Relaxant
- Cyclobenzaprine (Flexeril)
- Indications
- Efficacy
- Agents: Preferred
- Cyclobenzaprine (Flexeril) 5 mg orally at bedtime up to three times daily
- Still expensive despite generic
- Best studied of all antispasmodic agents
- Methocarbamol (Robaxin) 750 to 1500 mg four times daily
- Significantly less expensive than Flexeril
- Warn about Urine Color change
- Cyclobenzaprine (Flexeril) 5 mg orally at bedtime up to three times daily
- Agents: Higher risk of Adverse Effects
- Chlorzoxazone (Parafon Forte) 250-750 mg 3-4 times daily
- Risk of liver abnormalities and GI upset
- Metaxalone (Skelaxin) 800 mg 3-4 times daily
- Risk of liver, hematologic abnormalities and GI upset
- Orphenadrine (Norflex) 100 mg twice daily
- Risk of Tachycardia, hematologic abnormalities and GI upset
- Tizanidine (Zanaflex) 4 mg orally every 6-8 hours (maximum 36 mg/day)
- Risk of hepatotoxicity and Blood Pressure changes
- Chlorzoxazone (Parafon Forte) 250-750 mg 3-4 times daily
- Agents: Higher risk of dependence
- Carisoprodol (Soma) 350 mg up to four times daily
- Schedule IV drug in U.S. as of January 2012
- Risk of transient neurologic changes, serious Allergic Reactions, Substance Abuse, and fatal overdoses
- Metabolized to Meprobamate, a sedative and FDA controlled substance similar to barbiturates
- Diazepam (Valium) 2-10 mg orally 3-4 times daily
- Carisoprodol (Soma) 350 mg up to four times daily
- References
- Presc Lettr (2012) Am Fam Physician 19(1): 6
- Beebe (2005) Am J Ther 12(2): 151-71
- Chou (2004) J Pain Symptom Manage 28(2):140-75
- See (2008) Am Fam Physician 78: 365-70
| Medication Costs | ||
|---|---|---|
| Methocarbamol (on 2/9/2012 at DrugStore.com) | ||
| Methocarbamol 500mg Tablets | #60 for $15.99 | ($0.27/unit) |
| Methocarbamol 750mg Tablets | #30 for $14.99 | ($0.50/unit) |
| Robaxin (on 2/9/2012 at DrugStore.com) | ||
| Robaxin 500mg Tablets | #30 for $65.40 | ($2.18/unit) |
| Robaxin-750 (on 2/9/2012 at DrugStore.com) | ||
| Robaxin-750 750mg Tablets | #30 for $82.83 | ($2.76/unit) |
| Chlorzoxazone (on 2/9/2012 at DrugStore.com) | ||
| Chlorzoxazone 500mg Tablets | #90 for $17.99 | ($0.20/unit) |
| Parafon Forte DSC (on 2/9/2012 at DrugStore.com) | ||
| Parafon Forte DSC 500mg Tablets | #30 for $92.99 | ($3.10/unit) |
| Metaxalone (on 2/9/2012 at DrugStore.com) | ||
| Metaxalone 800mg Tablets | #30 for $119.99 | ($4.00/unit) |
| Skelaxin (on 2/9/2012 at DrugStore.com) | ||
| Skelaxin 800mg Tablets | #30 for $141.74 | ($4.72/unit) |
| Orphenadrine Citrate CR (on 2/9/2012 at DrugStore.com) | ||
| Orphenadrine Citrate CR 100mg 12 Hour Tablets | #30 for $48.99 | ($1.63/unit) |
| Orphenadrine Compound-DS (on 2/9/2012 at DrugStore.com) | ||
| Orphenadrine Compound-DS 50-770-60mg Tablets | #30 for $75.99 | ($2.53/unit) |
| TiZANidine HCl (on 2/9/2012 at DrugStore.com) | ||
| TiZANidine HCl 2mg Tablets | #90 for $29.99 | ($0.33/unit) |
| Zanaflex (on 2/9/2012 at DrugStore.com) | ||
| Zanaflex 4mg Tablets | #90 for $249.99 | ($2.78/unit) |
| Zanaflex 2mg Capsules | #100 for $285.34 | ($2.85/unit) |
| Zanaflex 4mg Capsules | #100 for $367.82 | ($3.68/unit) |
| Zanaflex 6mg Capsules | #100 for $533.31 | ($5.33/unit) |
| Carisoprodol-Aspirin (on 2/9/2012 at DrugStore.com) | ||
| Carisoprodol-Aspirin 200-325mg Tablets | #30 for $65.99 | ($2.20/unit) |
| Carisoprodol-Aspirin-Codeine (on 2/9/2012 at DrugStore.com) | ||
| Carisoprodol-Aspirin-Codeine 200-325-16mg Tablets | #30 for $82.99 | ($2.77/unit) |
| Carisoprodol (on 2/9/2012 at DrugStore.com) | ||
| Carisoprodol 350mg Tablets | #30 for $14.99 | ($0.50/unit) |
| Soma (on 2/9/2012 at DrugStore.com) | ||
| Soma 350mg Tablets | #30 for $199.49 | ($6.65/unit) |
| Soma 250mg Tablets | #100 for $352.00 | ($3.52/unit) |
| Soma Compound (on 2/9/2012 at DrugStore.com) | ||
| Soma Compound 200-325mg Tablets | #30 for $139.99 | ($4.67/unit) |
| FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. | ||
Carisoprodol (C0007248) |
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|---|---|
| Definition (MSH) | A centrally acting skeletal muscle relaxant whose mechanism of action is not completely understood but may be related to its sedative actions. It is used as an adjunct in the symptomatic treatment of musculoskeletal conditions associated with painful muscle spasm. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1202) |
| Definition (NCI) | A synthetic propanediol dicarbamate derivative and an adjunct in the treatment of painful muscle spasms, Carisoprodol is a centrally acting skeletal muscle relaxant that relieves stiffness, pain, and discomfort caused by muscle injuries. Its mechanism of action is not clear yet; perhaps due to its sedative actions. (NCI04) |
| Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
| MSH | D002328 |
| SnomedCT | 25076002, 387133006 |
| English | Carisoprodate, Carisoprodol, Isobamate, Isomeprobamate, Isopropylmeprobamate, Carbamic acid, (1-methylethyl)-, 2-(((aminocarbonyl)oxy)methyl)-2-methylpentyl ester, carisoprodol, muscle relaxants skeletal carisoprodol, carisoprodol (medication), CARISOPRODOL, Carisoprodol [Chemical/Ingredient], isopropylmeprobamate, Carisoprodol (product), Carisoprodol (substance) |
| Swedish | Karisoprodol |
| Czech | karisoprodol |
| Finnish | Karisoprodoli |
| Italian | Isobamato, Carisoprodato, Isomeprobamato, Isopropilmeprobamato, Carisoprodolo |
| Russian | IZMEPROBAMAT, IZOPROPILMEPROBAMAT, IZOPROPAN, KARIZOPRODAT, IZOBAMAT, SKUTAMIL, KARIZOPRODOL, ИЗМЕПРОБАМАТ, ИЗОБАМАТ, ИЗОПРОПАН, ИЗОПРОПИЛМЕПРОБАМАТ, КАРИЗОПРОДАТ, КАРИЗОПРОДОЛ, СКУТАМИЛ |
| Polish | Soma, Karizoprodol |
| Japanese | イソバメート, イソプロピルメプロバメート, イソメプロバメート, カリソプロデート, カリソプロドール |
| Spanish | carisoprodato, carisoprodol (producto), carisoprodol (sustancia), carisoprodol, isobamato, isopropilmeprobamato, Carisoprodato, Carisoprodol, Isobamato, Isomeprobamato, Isopropilmeprobamatos |
| French | Carisoprodol |
| German | Carisoprodat, Carisoprodol, Isobamat, Isomeprobamat, Isopropylmeprobamat |
| Portuguese | Carisoprodato, Carisoprodol, Isobamato, Isomeprobamato, Isopropilmeprobamato |
| Sources |
Derived from the NIH UMLS (Unified Medical Language System) |
Chlorzoxazone (C0008296) |
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|---|---|
| Definition (NCI) | A benzoxazolone derivative with mild sedative and centrally-acting muscle relaxant activities. Although its exact mechanism of action is unknown, chlorzoxazone (CZ) appears to act at the spinal cord and subcortical levels of the brain to inhibit multisynaptic reflex arcs involved in producing and maintaining muscle spasms. This agent is extensively hydroxylated by cytochrome P450 2E1 (CYP2E1) to 6-hydroxychlorzoxazone (HCZ),11,12 which is subsequently glucuronidated and eliminated renally. Highly selective for CYP2E1, CZ may be used as a selective probe for phenotyping CYP2E1 in humans; the ratio of HCZ-to-CZ plasma concentrations obtained 2 to 4 hours after oral administration of CZ may be used as a phenotypic measure of CYP2E1 enzymatic activity. |
| Definition (MSH) | A centrally acting central muscle relaxant with sedative properties. It is claimed to inhibit muscle spasm by exerting an effect primarily at the level of the spinal cord and subcortical areas of the brain. (From Martindale, The Extra Pharmacopoea, 30th ed, p1202) |
| Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
| MSH | D002753 |
| SnomedCT | 400361007, 44908000 |
| English | Chlorzoxazone, 2(3H)-Benzoxazolone, 5-chloro-, chlorzoxazone, muscle relaxants skeletal chlorzoxazone, chlorzoxazone (medication), Chlorzoxazone [Chemical/Ingredient], CHLORZOXAZONE, chlorzoxozone, Chlorzoxozone, Chlorzoxozone (product), Chlorzoxozone (substance) |
| Swedish | Klorzoxazon |
| Czech | chlorzoxazon |
| Finnish | Klooritsoksatsoni |
| Russian | KHLORZOKSAZON, ХЛОРЗОКСАЗОН |
| Japanese | クロルゾキサゾン |
| Spanish | clorzoxazona, clorzoxozona (producto), clorzoxazona (producto), clorzoxozona (sustancia), clorzoxozona, Clorzoxazona |
| Polish | Chlorzoksazon |
| French | Chlorzoxazone |
| German | Chlorzoxazon |
| Italian | Clorozossazone |
| Portuguese | Clorzoxazona |
| Sources |
Derived from the NIH UMLS (Unified Medical Language System) |
Methocarbamol (C0025659) |
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|---|---|
| Definition (MSH) | A centrally acting muscle relaxant whose mode of action has not been established. It is used as an adjunct in the symptomatic treatment of musculoskeletal conditions associated with painful muscle spasm. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1206) |
| Definition (NCI) | A carbamate with centrally acting muscle relaxant properties. Though the exact mechanism of action of methocarbamol was not established, it's postulated to be via a mechanism similar of carbamate, inhibition of acetylcholinesterase at synapses in the autonomic nervous system, neuromuscular junction, and central nervous system. Methocarbamol has no direct effect on the contractile mechanism of striated muscle, the motor end plate or the nerve fiber. |
| Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
| MSH | D008721 |
| SnomedCT | 387486000, 83973001 |
| English | Carbamate, Guaiphenesin, Guaiphenesin Carbamate, Methocarbamol, 1,2-Propanediol, 3-(2-methoxyphenoxy)-, 1-carbamate, methocarbamol, methocarbamol (medication), muscle relaxants skeletal methocarbamol, METHOCARBAMOL, Methocarbamol [Chemical/Ingredient], Methocarbamol (product), Methocarbamol (substance) |
| Swedish | Metokarbamol |
| Czech | methokarbamol |
| Finnish | Metokarbamoli |
| Russian | GVAIFENEZINKARBAMAT, METOKARBAMOL, ГВАЙФЕНЕЗИНКАРБАМАТ, МЕТОКАРБАМОЛ |
| Japanese | メトカルバモル, ロバキシン, メトカルバモール, グアイフェネシンカルバメート |
| Polish | Robaksyna, Metokarbamol |
| Spanish | metocarbamol (producto), metocarbamol (sustancia), metocarbamol, Carbamato de Guaifenesina, Metocarbamol |
| French | Méthocarbamol |
| German | Guaiphenesincarbamat, Methocarbamol |
| Italian | Metocarbammolo |
| Portuguese | Carbamato de Guaifenesina, Metocarbamol |
| Sources |
Derived from the NIH UMLS (Unified Medical Language System) |
Orphenadrine (C0029309) |
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|---|---|
| Definition (NCI) | A muscarinic antagonist with muscle relaxant activity. Although the mechanism of action has not been determined, orphenadrine appears to block muscarinic acetylcholine receptors as well as N-methyl-D-aspartate (NMDA) receptors in the central nervous system (CNS). This may interfere with the transmission of nerve impulses from the spinal cord to the muscles and may help relax muscles. In addition, orphenadrine exerts antagonistic effects on histamine H1 receptors. |
| Definition (MSH) | A muscarinic antagonist used to treat drug-induced parkinsonism and to relieve pain from muscle spasm. |
| Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
| MSH | D009966 |
| SnomedCT | 35035001, 372714007 |
| English | Methyldiphenylhydramine, Orphenadrine, Ethanamine, N,N-dimethyl-2-((2-methylphenyl)phenylmethoxy)-, orphenadrine (medication), orphenadrine, Orphenadrine [Chemical/Ingredient], Orphenadrine (product), Orphenadrine (substance), ORPHENADRINE |
| Swedish | Orfenadrin |
| Czech | orfenadrin |
| Finnish | Orfenadriini |
| Russian | ORFENADRIN, METILDIFENILGIDRAMIN, МЕТИЛДИФЕНИЛГИДРАМИН, ОРФЕНАДРИН |
| Japanese | オルフェナドリン, メチルジフェニルヒドラミン |
| Polish | Orfenandryna, Metylodifenylohydramina |
| Spanish | orfenadrina (producto), orfenadrina (sustancia), orfenadrina, Metildifenilhidramina, Orfenadrina |
| French | Orphénadrine |
| German | Methyldiphenylhydramin, Orphenadrin |
| Italian | Orfenadrina |
| Portuguese | Metildifenilidramina, Orfenadrina |
| Sources |
Derived from the NIH UMLS (Unified Medical Language System) |
Skeletal Muscle Relaxants (C0037250) |
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|---|---|
| Concepts | Pharmacologic Substance (T121) |
| MSH | D009465 |
| SnomedCT | 17893001, 372666009 |
| English | Muscle Relaxants, Skeletal, Relaxants, Skeletal Muscle, SKELETAL MUSCLE RELAXANTS, Skeletal muscle relaxant, NOS, Skeletal muscle tone depressant, NOS, skeletal muscle relaxants, skeletal muscle relaxants (medication), muscle relaxants skeletal, 687-688 SKELETAL MUSCLE RELAXANTS, Skeletal Muscle Relaxant, Skeletal Muscle Relaxant [EPC], [MS200] SKELETAL MUSCLE RELAXANTS, skeletal muscle relaxant, Skeletal muscle relaxant, Skeletal muscle relaxant (product), Skeletal muscle relaxant (substance), Skeletal muscle tone depressant, Skeletal Muscle Relaxants |
| French | Myorelaxants, Décontracturants des muscles striés, Relaxants musculaires, Myorésolutifs, Décontracturants, Décontracturants musculaires, Relaxants des muscles squelettiques |
| Czech | myorelaxancia |
| Portuguese | Relaxantes Musculosqueléticos |
| Spanish | Relajantes del Musculo Esquelético, Relajantes del Musculo Esqueletico, depresor del tono muscular esquelético, miorrelajante esquelético, relajante de músculo esquelético (sustancia), relajante de músculo esquelético, relajante del músculo esquelético (producto), relajante del músculo esquelético (sustancia), relajante del músculo esquelético |
| German | Skelettmuskelrelaxanzien |
| Sources |
Derived from the NIH UMLS (Unified Medical Language System) |
tizanidine (C0146011) |
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|---|---|
| Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
| MSH | C023754 |
| SnomedCT | 108461005, 373440006 |
| English | 2,1,3-Benzothiadiazol-4-amine, 5-chloro-N-(4,5-dihydro-1H-imidazol-2-yl)-, 5-chloro-4-(2-imidazolin-2-yl-amino)-2,1,3-benzothiadiazole, tizanidine, tizanidine [Chemical/Ingredient], tiZANidine, Tizanidine, Tizanidine (product), Tizanidine (substance), TIZANIDINE |
| Spanish | tizanidina (producto), tizanidina (sustancia), tizanidina |
| Sources |
Derived from the NIH UMLS (Unified Medical Language System) |
metaxalone (C0163055) |
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|---|---|
| Definition (NCI) | An oxazolidinone with centrally-acting skeletal muscle relaxant properties. Although the exact mechanism through which metaxalone exerts its effect is largely unknown, it might be due to general central nervous system (CNS) depression. Metaxalone has no direct effect on the contractile mechanisms of striated muscle, the motor end plate, or the nerve fiber. |
| Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
| MSH | C011301 |
| SnomedCT | 87599003, 404863006 |
| English | 5-((3,5-dimethylphenoxy)methyl)-2-oxazolidinone, metaxalone, Zorane, 2-Oxazolidinone, 5-((3,5-dimethylphenoxy)methyl)-, metaxalone (medication), muscle relaxants skeletal metaxalone, METAXALONE, metaxalone [Chemical/Ingredient], Metaxalone, Metaxalone (substance), Metaxalone (product) |
| Spanish | metaxalona (sustancia), metaxalona, metaxalona (producto) |
| Sources |
Derived from the NIH UMLS (Unified Medical Language System) |