The Massachusetts General Hospital Handbook of Neurology
Authors: Flaherty, Alice W.; Rost, Natalia S.
Title: Massachusetts General Hospital Handbook of Neurology, The, 2nd Edition
Copyright 2007 Lippincott Williams & Wilkins
> Table of Contents > Drugs > Muscle Relaxants
Muscle Relaxants
A. See also
Benzodiazepines, p. 165.
B. Baclofen
A GABA-B agonist. For spasticity, back pain, trigeminal neuralgia.
Dosing: Start 5-10 mg PO bid, to 10-30 tid.
Side effects: Sedation, weakness, nausea, depression. If stopped suddenly after several weeks of heavy use, can trigger seizures.
C. Dantrolene
A direct muscle relaxant.
Dosing: see p. 170 for dosing in neuroleptic malignant syndrome. For spasticity, start 25 mg PO qd, up to 400 mg qd divided bid/qid.
Side effects: Hepatotoxicity, CHF, sedation.
P.174
D. Tizanidine (Zanaflex)
2-adrenergic agonist, used for spasticity.
Dosing: Varies widely across pts., from 2-39 mg PO qd; must titrate over 2-4 wk because it takes about a week to reach max. effect.
Side effects: Sedation, weakness (less than baclofen), dry mouth.
E. Cyclobenzaprine (Flexeril)
Central muscle relaxant.
Dosing: 5-10 mg tid; do not use for more than 3 weeks.
Side effects: Sedation, dizziness, dry mouth.
F. Quinine
Not an FDA-approved indication, but helps some pts.
Dosing: Try 300 mg PO qhs.
Side effects: Cinchonism with overdose. Hemolysis with G6PD deficiency.