II. Precautions
- 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
- Two tablets (700 mg dose) may require Endotracheal Intubation in infants
III. Mechanism
- Carisoprodol is a centrally acting Skeletal Muscle Relaxant
-
Meprobamate is primary active metabolite
- Barbiturate-like effects at GABA-A Receptors
IV. Dosing
- Carisoprodol (Soma) 350 mg up to four times daily
V. Pharmacokinetics
VI. Adverse Effects: Toxicity or Overdose
- Myoclonic encephalopathy (abnormal movements)
- Agitation
- Lethargy to coma (Meprobamate related)
- Seizures (rare)
- Cardiopulmonary depression (apnea, Acute Heart Failure)
- Withdrawal symptoms (e.g. Delirium) after cessation
VII. Labs: Toxicity
- See Unknown Ingestion
- Complete Blood Count (CBC)
- Comprehensive Metabolic Panel (Chem18)
- Creatinine Kinase (CK)
VIII. Diagnostics: Toxicity
- Electrocardiogram (EKG)
- Consider CT Head, Electroencephalogram (EEG)
IX. Management: Toxicity
- Supportive Care
- ABC Management
- Endotracheal Intubation as indicated
- Gastric Decontamination is not typically indicated
- Sedation for Agitation, rigidity
- Antidotes
- May consider Flumazenil (but risk of severe withdrawal if concurrent Benzodiazepine Abuse)
- Roberge (2000) J Emerg Med 18(1):61-4 +PMID: 10645840 [PubMed]
X. References
- Sun and Tomaszewski (2017) Crit Dec Emerg Med 31(12): 24
- Høiseth (2008) Clin Toxicol 46(4):307-9 +PMID: 18363125
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Related Studies
| carisoprodol (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| CARISOPRODOL 250 MG TABLET | Generic | $0.78 each |
| CARISOPRODOL 350 MG TABLET | Generic | $0.05 each |