Tizanidine

Tizanidine is an oral medication used to treat symptoms caused by multiple sclerosis or spinal injuries.

Overview:

Though it doesn’t work as a cure, it allows the patient to access other treatment, including physical therapy, which can help toward both improving and managing the patient’s condition. The medicine works by relieving cramping, spasms and tightness of the muscles caused by their medical condition.

The medicine works by acting on the central nervous system in order to produce its muscle relaxant effects. However the actions on the central nervous system may also be the catalyst for the Tizanidine’s side effects.

Conditions treated:

  • Muscle spasticity in adults – Caused by multiple sclerosis or certain injuries to the spine

Type of medicine:

  • Muscle relaxant

Side Effects:

For those patients that have taken Tizanidine the most common side effects experienced have been chest pain or discomfort and fever or chills. Other side effects reported by patients include nausea or vomiting, nervousness and pain or burning while urinating.

As with all medicines, along with its required effects, there is the possibility of additional side effects being caused. If side effects of taking Tizanidine continue, patients are advised to consult with a healthcare professional and if they have any concerns, to highlight these to a doctor.

Patients should make their doctor aware if they experience these side effects in particular: unusual tiredness, blurred vision and flu-like symptoms. Pay particular attention to irregular heartbeat, itching skin, kidney stones and right upper stomach tenderness. Other patients have been known to experience seeing things that are not there, light-colored stools, shortness of breath, unexpected weight gain, continued vomiting, generally feeling tired or weak and persistent headaches.

Patients are always advised to check with their doctor or healthcare Professional over any concerns that they may have. With Tizanidine, as with all medicines, there is always the possibility of accidentally overdosing on the medicine. If this was to occur, then the patient is advised to seek emergency help as soon as possible if they were to experience the following symptoms of blurred vision, change in consciousness and chest pain or discomfort.

Other symptoms of overdosing on Tizanidine that patients have experienced include confusion, decreased awareness or responsiveness, difficult or troubled breathing, lightheadedness, irregular, fast or slow, or shallow breathing and pale lips, fingernails or skin. It has been reported that severe sleepiness and sweating have also been a result of overdosing on Tizanidine.

Usually, most common side effects would not require medical attention and throughout treatment these side effects do subside as the body adjusts. If a patient has concerns they can discuss these with a healthcare professional who can advise on ways in which to either reduce or prevent these side effects.

If side effects such as drowsiness, weakness and constipation continue to prove troublesome for patients, they can seek guidance from a healthcare professional. If a patient experiences any side effects not listed, then they can check with their healthcare professional.

Dosage:

As with all medication, the patient must take Tizanidine as directed by their doctor and should not take more than the prescribed amount. Doing this would increase the chance of experiencing side effects.

Tizanidine can be taken with food, this affects the amount of medicine absorbed into the blood. It is key that the doctor’s instructions are followed in terms of how to take the medicine and whether or not it should be taken with food.

The dosage depends on the patient’s condition and is outlined by the doctor, it is key that they follow these orders or the directions on the label. The information below is based on the average doses of this medicine. If a patient’s dose is different, they cannot change it unless ordered to by the doctor.

Amount taken depends upon medicine strength, the number of doses per day, time between doses and the length of time depends upon the patient’s medical condition.

For oral dosage forms (capsules or tablets):

For muscle relaxation:

Adults—at first, 2 milligrams (mg) every six to eight hours. The doctor may adjust the dose as needed. The patient cannot take more than 36 mg within a 24-hour period.

Children—Use and dose must be determined by the doctor.

Missed Dose

If a patient misses a dose of Tizanidine, they must take it as soon as possible. However, if it is almost time for the patient’s next dose, they must skip the missed dose and go back to their regular dosing times. The patient must not double dose.

Interactions:

Certain medicines cannot be combined at all, however there are cases in which two different medicines may be used, even if an interaction might occur. If this is the case, the doctor may want to change the dose or take other precautions. It is important that the patient ensures that they notify their health care professional if they are taking any of the listed medications below. These interactions are based on their potential significance and are not all-inclusive:

  • Amifampridine
  • Amisulpride
  • Bepridil
  • Ciprofloxacin
  • Cisapride
  • Dronedarone
  • Fluvoxamine
  • Mesoridazine
  • Pimozide
  • Saquinavir
  • Sparfloxacin
  • Terfenadine
  • Thioridazine
  • Ziprasidone

The following medicines should not be used with Tizanidine, but may be required. If both are prescribed by the doctor, they will change the dose or how often both of the medicines are used.

  • Alfentanil
  • Alfuzosin
  • Amiodarone
  • Anagrelide
  • Anileridine
  • Aripiprazole
  • Arsenic Trioxide
  • Asenapine
  • Astemizole
  • Bedaquiline
  • Bromazepam
  • Buprenorphine
  • Buserelin
  • Butorphanol
  • Cimetidine
  • Citalopram
  • Clarithromycin
  • Codeine
  • Crizotinib
  • Cyclobenzaprine
  • Dabrafenib
  • Deferasirox
  • Degarelix
  • Delamanid
  • Deslorelin
  • Desogestrel
  • Dienogest
  • Dihydrocodeine
  • Disopyramide
  • Dofetilide
  • Domperidone
  • Donepezil
  • Doxylamine
  • Droperidol
  • Drospirenone
  • Efavirenz
  • Erythromycin
  • Escitalopram
  • Estradiol Valerate
  • Ethinyl Estradiol
  • Ethynodiol Diacetate
  • Famotidine
  • Fentanyl
  • Flecainide
  • Flibanserin
  • Fluconazole
  • Fluoxetine
  • Gatifloxacin
  • Gestodene
  • Gonadorelin
  • Goserelin
  • Halofantrine
  • Haloperidol
  • Histrelin
  • Hydrocodone
  • Hydromorphone
  • Hydroquinidine
  • Hydroxychloroquine
  • Hydroxyzine
  • Ibutilide
  • Iloperidone
  • Ivabradine
  • Ketoconazole
  • Lapatinib
  • Leuprolide
  • Levofloxacin
  • Levonorgestrel
  • Levorphanol
  • Lumefantrine
  • Mefloquine
  • Meperidine
  • Mestranol
  • Methadone
  • Metronidazole
  • Mexiletine
  • Mizolastine
  • Morphine
  • Morphine Sulfate Liposome
  • Moxifloxacin
  • Nafarelin
  • Nilotinib
  • Norethindrone
  • Norfloxacin
  • Norgestimate
  • Norgestrel
  • Ofloxacin
  • Ondansetron
  • Oxycodone
  • Oxymorphone
  • Paliperidone
  • Panobinostat
  • Pasireotide
  • Pazopanib
  • Peginterferon Alfa-2b
  • Pentamidine
  • Pentazocine
  • Periciazine
  • Pimavanserin
  • Pitolisant
  • Pixantrone
  • Posaconazole
  • Procainamide
  • Propafenone
  • Propoxyphene
  • Quetiapine
  • Quinidine
  • Quinine
  • Ranolazine
  • Remifentanil
  • Rofecoxib
  • Sertindole
  • Sevoflurane
  • Sodium Phosphate
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate, Monobasic
  • Sotalol
  • Sufentanil
  • Sulpiride
  • Sunitinib
  • Tacrolimus
  • Tapentadol
  • Telithromycin
  • Tetrabenazine
  • Ticlopidine
  • Tiotropium
  • Tramadol
  • Triptorelin
  • Vandetanib
  • Vemurafenib
  • Verapamil
  • Vinflunine
  • Voriconazole
  • Zileuton
  • Zolpidem
  • Zuclopenthixol

The following listed medicines may see an increase in certain side effects if the patient is also taking Tizanidine, but the doctor may decide that taking both is the best treatment for the patient. If both are prescribed, then the doctor may change the dose.

  • Fosphenytoin
  • Lisinopril
  • Phenytoin

If eating food or eating certain types of food, certain medicines may trigger interactions. Using alcohol and tobacco with Tizanidine may also cause an interaction to occur.

The patient should have a conversation with their doctor if they have experienced any addictions or currently are taking any kind of substance that could cause an interaction. Patients should avoid drinking alcohol if they can and should discuss any concerns and queries they have with their doctor or a healthcare professional.

Warnings:

When it comes to using Tizanidine, the doctor must decide with the patient as to the risks of taking the medicine against the effectiveness of the treatment. With this in mind, the doctor would consider:

Allergies

The patient must make their doctor aware if they have ever had an unusual or allergic reaction to Tizanidine or any other kind of medication. It is also imperative that the patient outlines any other allergies they may have, such as to foods, dyes, preservatives, or animals.

Pediatric

In terms of the effects of tizanidine in the pediatric population, no studies have been performed, which means the safety and efficacy has not been established.

Geriatric

Through studies, no geriatric-specific problems have been demonstrated in the use of tizanidine. There is the possibility that the more elderly patients may have kidney problems, this means that caution must be taken when tizanidine is prescribed.

Pregnancy

There have been no detailed studies on pregnant women as to the effects of tizanidine.

Breastfeeding

In determining infant risk when using tizanidine, no detailed studies have been completed on using this medication and its risk to both mother and infant during breastfeeding. It is key then that the doctor ensures they weigh up the potential implications before prescribing.

Other Medical Problems

If a patient has a pre-existing health condition, this may affect the effectiveness of the medication, a patient must notify the doctor if they have any conditions, taking particular note of:

  • Kidney disease or
  • Liver disease

If the patient is using either ciprofloxacin or fluvoxamine, then they must not use tizanidine, as using these together could cause serious and unwanted side effects to the patient.

If the patient experiences dizziness, lightheadedness, or fainting when they get up suddenly from a lying or sitting position, then they are advised to do this slowly as this may help to alleviate the effects of this problem.

Patients are advised to seek support and advice from their doctor if they experience pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be the tell-tale signs of a serious liver condition.

Tizanidine is a medicine that will add to the effects of alcohol and other CNS depressants, this will make the patient drowsy and less alert. This means that the patient is not recommended to operate any machinery through treatment and avoid driving. Some other CNS depressants include antihistamines or medicine for hay fever, other allergies, or colds, sedatives, tranquilizers, or sleeping medicine, prescription pain medicine or narcotics, barbiturates, medicine for seizures, other muscle relaxants, or anaesthetics, including some dental anaesthetics. It is vital that the patient checks with the doctor before taking any of these while they are currently on a course of Tizanidine.

Tizanidine may cause dizziness, drowsiness, lightheadedness, clumsiness or unsteadiness, or vision problems in some patients. If they do have to drive or operate machinery, then it is vital that they know how to react to this. It could be dangerous if the patient is not alert, well-coordinated and able to see well.

Some patients have been known to experience hallucinations while they have been completing treatment of tizanidine. If a patient starts to experience hallucinations, then they must check with their doctor as soon as possible if this is the case.

Rebound hypertension and tachycardia have been reported after sudden withdrawal of tizanidine, when it had been used chronically, and/or in high daily dosages, and/or with antihypertensive drugs. In extreme cases, rebound hypertension might lead to a cerebrovascular accident.

As with all types of medicine, tizanidine may cause serious allergic reactions, including anaphylaxis. This can be life-threatening and would require immediate medical attention. If a patient is experiencing a rash, itching, trouble breathing, trouble swallowing, or any swelling of the hands, face, or mouth while they are using the medicine, then they must contact their doctor as soon as possible.

Tizanidine has been reported as to cause dryness in the mouth of some patients. To alleviate this, patients are recommended to use sugarless candy or gum, melt bits of ice in their mouth, or use a saliva substitute. If a dry mouth continues for more than a two week period, then a patient must consult with their doctor or dentist. Continued dryness in the patient’s mouth could potentially lead to an increase in the chances of dental disease, tooth decay, gum disease and fungus infections.

Storage:

Patients must store tizanidine in a closed container at room temperature, ensuring it is kept away from heat, moisture and direct light. They must also ensure it does not freeze.

As with all medicines, it must be kept out of reach of children, to not keep tizanidine if it is out of date or is no longer required.

If tizanidine needs to be disposed of, then the patient must enquire with a health care professional, the best way of disposing of tizanidine.

Summary

Tizanidine works in helping to relax certain muscles in the patient’s body. It does this by relieving spasms, cramping and any tightness of the muscles that may occur. These kinds of conditions can be caused by multiple sclerosis or certain injuries to the spine.

It does not work as a cure, but instead works best in conjunction with other treatments such as physical therapy in helping a patient to manage or improve their condition.

Tizanidine is derived from imidazoline and works as a centrally acting muscle relaxant used for therapy of acute muscle spasms and chronic spasticity. The way in which tizanidine causes the skeletal muscles to relax is not well known. Through study it appears to work at the level of spinal cord pain reflexes, through activity as a central alpha-adrenergic agonist which results in a decrease in activity of motor neurons.

The medicine was approved for use in the United States in 1996 and there are several million prescriptions filled yearly. The current information seems limited to the short-term management of conditions. It is available in different forms and under the brand name of Zanflex in tablets and capsules of 2, 4 or 6 mg. Common side effects include tiredness, drowsiness, dizziness, muscular weakness, dry mouth and occasionally hypotension.

Throughout treatment, the doctor would check the patient’s progress, especially during the initial weeks of treatment. The purpose of these checks would be for the doctor to check that the medicine is effective in alleviating symptoms and to look out for any unwanted effects of the medication.

If a patient wishes to stop taking tizanidine they are to do so only in accordance with directions from their doctor. The doctor may decide to gradually reduce the amount a patient uses before stopping completely. This helps to prevent the possibility of their condition taking a turn for their worse and also reduce the possibility of a patient suffering withdrawal symptoms.

As with all medicines, the benefits will also come with a cache of side effects, though it is important to note that a patient may not experience any if at all these side effects. However, as always, it is for the doctor to decide on the benefits of the medicine against the risks of side effects on the patient’s body.

As always, if a patient should have any questions or concerns, they should discuss these with their doctor.

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Last Reviewed:
December 24, 2017
Last Updated:
December 22, 2017
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