II. Indications
III. Mechanism
- Antispasmodic Skeletal Muscle Relaxant
- Centrally acting cyclical Antidepressant with Sedative qualities
- Tricyclic amine salt similar to Amitriptyline
- Reduces Muscle hyperactivity and somatic motor activity
- Mechanism may act at 5-H2 receptors, inhibiting descending serotonergic pathways in the cord
IV. Dosing: Immediate Release
- Start: 5 mg orally at bedtime (5 mg is as effective as 10 mg and with less sedation)
- Maximum: 10 mg orally three times daily (primarily at bedtime for pain interfering with sleep)
V. Dosing: Extended Release
- Start 15 mg orally daily
- Maximum: 30 mg orally daily
VI. Contraindications
- Older patients
- Seizure Disorder (if concurrently on Tramadol)
- Glaucoma
- Cardiac Arrhythmia
- Congestive Heart Failure
- Recent Myocardial Infarction
VII. Efficacy
- See Antispasmodic Skeletal Muscle Relaxant
- Poor evidence for benefit
- More effective than Placebo for first 4 days of Low Back Pain
- However, no significant functional or pain benefit at 1 week for Acute Low Back Pain (non-Traumatic, non-radicular)
VIII. Adverse effects
- See Antispasmodic Skeletal Muscle Relaxant for precautions
- Common: Anticholinergic
- Rare
- Arrhythmia
- Reflex Tachycardia
- Cyclobenzaprine may block alpha-1 Adrenergic Receptors resulting in vasodilation
- QRS Widening
- Fast-acting Sodium channel blockade (as with Amitriptyline)
- Reflex Tachycardia
- Seizure
- GABA Receptor inhibition may lower Seizure threshold
- Myocardial Infarction
- Serotonin Syndrome
- Risk when Cyclobenzaprine is combined with other serotonergic drugs
- Arrhythmia
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Related Studies
| cyclobenzaprine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| CYCLOBENZAPRINE 10 MG TABLET | Generic | $0.02 each |
| CYCLOBENZAPRINE 5 MG TABLET | Generic | $0.02 each |
| CYCLOBENZAPRINE 7.5 MG TABLET | Generic | $0.66 each |
Ontology: cyclobenzaprine (C0056732)
| Definition (NCI) | A centrally acting skeletal muscle relaxant with antidepressant activity. The exact mechanism of action of cyclobenzaprine has not been fully determined, but this drug seems to primarily act at the brain stem to reduce tonic somatic motor activity, influencing both gamma and alpha motor neurons leading to a reduction in muscle spasms. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C004704 |
| SnomedCT | 373779004, 80802008 |
| LNC | LP17189-9, MTHU004256 |
| English | cyclobenzaprine, N,N-dimethyl-3-(dibenzo(a,d)cycloheptene-4-ylidene)propylamine, cyclobenzaprine [Chemical/Ingredient], CYCLOBENZAPRINE, Cyclobenzaprine, Cyclobenzaprine (product), Cyclobenzaprine (substance) |
| Spanish | ciclobenzaprina (producto), ciclobenzaprina (sustancia), ciclobenzaprina |
