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Muscle Spasm Treatments
| MUSCLE SPASM TREATMENTS | |||||
|---|---|---|---|---|---|
| Generic | Brand | Strength | Form | Usual Adult Dose | |
| Alpha2-ADRENERGIC AGONIST | |||||
| tizanidine HCl | Zanaflex | ℞ | 4mg | scored tabs | Usually 4mg, may increase by 2−4mg as needed every 6−8hrs to a max of 3 doses in 24hrs; max 12mg/dose and 36mg/day. Renal impairment (CrCl <25mL/min): Reduce dose. May sprinkle contents of capsules on applesauce (may affect absorption). Tabs and caps not bioequivalent under fed conditions. |
| 2mg, 4mg, 6mg | caps | ||||
| ANTICHOLINERGIC MUSCLE RELAXANT (CENTRAL) | |||||
| orphenadrine citrate | — | ℞ | 100mg | sust-rel tabs | 100mg twice daily in AM and PM |
| ℞ | 60mg/2mL | inj1 | 60mg IM or IV every 12hrs | ||
| BENZODIAZEPINE | |||||
| diazepam | — | CIV | 5mg/5mL | soln | 2−10mg 3−4 times daily. Elderly, debilitated: Initially 2−2.5mg 1−2 times daily; increase gradually. |
| 5mg/mL | inj4 | Initially 5−10mg slow IV (5mg/min) or IM. May repeat after 3−4hrs. Tetanus: May need larger dose. Do not use small vein. | |||
| Diazepam Intensol | CIV | 5mg/mL | concen– trated soln2 | 2−10mg 3−4 times daily Elderly, debilitated: Initially 2−2.5mg 1−2 times daily; increase gradually. Mix with liquid or semi-solid food. | |
| Valium | CIV | 2mg, 5mg, 10mg | scored tabs | 2−10mg 3−4 times daily Elderly, debilitated: Initially 2−2.5mg 1−2 times daily; increase gradually. | |
| MUSCLE RELAXANT (CENTRAL) | |||||
| baclofen | — | ℞ | 5mg, 10mg+, 20mg+ | tabs (+scored) | 5mg 3 times daily; increase in increments of 5mg 3 times daily every 3 days if needed; max 80mg daily |
| Gablofen | ℞ | 50mcg/mL, 500mcg/ mL, 1000mcg/ mL, 2000mcg/ mL | intra– thecal inj | Give test dose 1st by intrathecal inj via spinal catheter or lumbar puncture (use 50mcg/mL syringe). Dose titration: see full labeling. Maintenance: titrate individually; maintain some degree of muscle tone. Spinal cord origin: usually 300–800mcg/day. Cerebral origin: usually 90–703mcg/day. | |
| Lioresal | ℞ | 50mcg/mL, 500mcg/ mL, 2000mcg/ mL | |||
| Lyvispah | ℞ | 5mg, 10mg, 20mg | oral granules | ≥12yrs: Initially 5mg 3 times daily for 3 days. May increase by increments of 5mg 3 times daily every 3 days, as needed; up to max 80mg/day. Can be dissolved in the mouth, swallowed, or mixed with up to 15mL of liquid or soft foods. | |
| carisoprodol | Soma | CIV | 350mg | tabs | ≥16yrs: 250−350mg 3 times daily and at bedtime; max 2−3wks <16yrs: Not established. |
| Soma 250 | CIV | 250mg | tabs | ||
| chlorzox– azone | — | ℞ | 375mg, 500mg+, 750mg+ | tabs (+scored) | 250–500mg 3–4 times daily. Painful musculoskeletal conditions: initially 500mg 3–4 times daily. May increase to 750mg 3–4 times daily if inadequate response. May reduce dose based on improvement. |
| cyclobenza– prine HCl | — | ℞ | 5mg, 10mg, 7.5mg | tabs | ≥15yrs: Initially 5mg 3 times daily; may increase to 10mg 3 times daily; max 2−3wks. Elderly or hepatic impairment: Initially 5mg, then titrate up. <15yrs: Not established. |
| Amrix | ℞ | 15mg, 30mg | ext-rel caps | 15mg once daily; may increase to 30mg once daily; max 2−3wks. Take at same time each day. Elderly or hepatic impairment: Not recommended. | |
| metaxalone | Skelaxin | ℞ | 800mg | scored tabs | 800mg 3−4 times daily. |
| methocar– bamol | — | ℞ | 500mg | tabs | ≥16yrs: Initially 1.5g 4 times daily for 2−3 days; if severe, may give up to 8g/day Maintenance: 1g 4 times daily <16yrs: Not established. |
| ℞ | 750mg | tabs | ≥16yrs: Initially 1.5g 4 times daily for 2−3 days; if severe, may give up to 8g/day. Maintenance: 750mg every 4hrs or 1.5g 3 times daily. <16yrs: Not established. | ||
| MUSCLE RELAXANT (LOCAL) | |||||
| dantrolene sodium | Dantrium | ℞ | 25mg, 50mg, 100mg | caps | 25mg once daily for 7 days, then 25mg 3 times daily for 7 days, then 50mg 3 times daily for 7 days, then 100mg 3 times daily; max 100mg 4 times daily |
| MUSCLE RELAXANT (CENTRAL) + SALICYLATE | |||||
| carisoprodol | — | ℞ | 200mg | tabs | 1−2 tabs 4 times daily |
| aspirin | 325mg | ||||
| MUSCLE RELAXANT (CENTRAL) + SALICYLATE + OPIOID | |||||
| carisoprodol | — | CIII | 200mg | tabs1 | 1−2 tabs 4 times daily |
| aspirin | 325mg | ||||
| codeine phosphate | 16mg | ||||
| NEUROMUSCULAR BLOCKERS | |||||
| abobotuli– numtoxin A | Dysport | ℞ | 300 U/vial, 500 U/vial | IM inj3 | Spasticity: usual range: 500–1000 Units (upper limb) or 1000–1500 Units (lower limb) divided among selected muscles per treatment session; max 1mL/site. Total max 1500 Units for upper and lower limb combined. May repeat treatment after effect of the previous inj diminishes, but no sooner than 12wks. |
| incobotuli– numtoxin A | Xeomin | ℞ | 50 U/vial, 100 U/vial, 200 U/vial | IM inj3 | See full labeling. Upper limb spasticity (not previously treated): initially give dose at the low end of dosing range and titrate as needed. Max cumulative dose: 400 Units in a treatment session. May repeat treatments no sooner than every 12wks. |
| onabotuli– numtoxin A | Botox | ℞ | 50 U/vial, 100 U/vial, 200 U/vial | IM inj3 | Upper limb spasticity: usual range: 75–400 Units divided among selected muscles per treatment session; max 50 Units/site. Lower limb spasticity: 300–400 Units divided among 5 muscles; max 50 Units/site. May repeat treatment after effect of the previous inj diminishes, but no sooner than 12wks. |
| NOTES | |||||
|
1contains sulfites; 2contains alcohol 19%; 3contains human albumin; 4contains propylene glycol 40%, ethyl and benzyl alcohol Not an inclusive list of medications and/or doses. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. (Rev. 10/2022) |
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