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 |