- Side Effects
- Drug Interactions
- Pregnancy & Breastfeeding
- What Else to Know
Generic Name: tizanidine
Brand Name: Zanaflex
Drug Class: Alpha2 adrenergic agonists
What is tizanidine, and what is it used for?
Muscle spasticity is a neuromuscular disorder that causes uncontrolled and prolonged contraction of muscles because of disrupted signals between the nerves and muscles. Tizanidine is effective for muscle spasticity caused by conditions such as multiple sclerosis, and brain, spinal cord or musculoskeletal injuries, all of which can damage nerves.
Tizanidine belongs to a class of medications known as alpha2 adrenergic agonists. Tizanidine acts on the central nervous system to produce muscle relaxation. Tizanidine stimulates alpha2 adrenergic receptors, protein molecules on nerve cells (neurons), and inhibits the motor neurons from releasing excitatory chemicals (neurotransmitters) such as glutamate and aspartate that are responsible for sending signals to the muscles to contract.
Tizanidine is approved by the FDA to treat muscle spasticity in adults. The off-label uses of tizanidine in adults include:
- Do not use in patients with hypersensitivity to tizanidine or any of its components
- Do not use tizanidine concurrently with ciprofloxacin, fluvoxamine or other potent CYP1A2 inhibiting drugs, can increase tizanidine concentration and effects.
- Concurrent use with CYP1A2 inducers can decrease tizanidine levels.
- Oral contraceptives can decrease tizanidine clearance, use with caution.
- Tizanidine can cause hypotension, orthostatic hypotension and syncope. Titrate dose with caution and monitor patients for symptoms.
- Tizanidine can cause liver injury, use with caution in patients with impaired liver function and monitor liver enzymes before and after therapy.
- Use tizanidine with caution in patients with renal impairment.
- Use with caution in geriatric patients.
- Tizanidine can cause sedation. Avoid concurrent use with other central nervous system (CNS) depressant drugs such as benzodiazepines and opioids, can have additive effect.
- Visual hallucinations and psychosis-like reactions can occur. If a patient develops such reactions, discontinue tizanidine.
- Tizanidine can cause severe hypersensitivity reactions including anaphylaxis and severe skin reactions such as Stevens-Johnson syndrome and exfoliative dermatitis. Discontinue the drug immediately in case of hypersensitivity.
- Abrupt discontinuation can cause rebound hypertension, tachycardia and hypertonia. Withdraw tizanidine gradually to reduce the risk of withdrawal symptoms.
What are the side effects of tizanidine?
Common side effects of tizanidine include:
- Drowsiness (somnolence)
- Dry mouth (xerostomia)
- Weakness or/and fatigue (asthenia)
- Slow heart rate (bradycardia)
- Low blood pressure (hypotension)
- Urinary tract infection
- Liver injury
- Elevated liver enzymes, particularly, alanine aminotransferase (ALT)
Less common side effects of tizanidine include:
- Urinary frequency
- Flu syndrome
- Nasal inflammation (rhinitis)
- Throat inflammation (pharyngitis)
- Blurred vision
- Speech disorder
- Movement disorder (dyskinesia)
- Withdrawal symptoms upon discontinuation include:
- Rare side effects of tizanidine include:
- Severe skin reactions including:
- Stevens-Johnson syndrome
- Exfoliative dermatitis
- Severe skin reactions including:
- Severe allergic reaction (anaphylaxis)
- Ventricular tachycardia
- Drop in blood pressure when standing up from sitting or lying down (orthostatic hypotension)
- Fainting (syncope)
- Liver inflammation (hepatitis)
- Joint pain (arthralgia)
- Abnormal skin sensations (paresthesia)
This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.
Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.
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What are the dosages of tizanidine?
- 2 mg
- 4 mg
- 2 mg
- 4 mg
- 6 mg
- Initial: 2 mg orally every 6-8 hours as needed; no more than 3 doses every 24 hours
- Maintenance: Titrate in 2-4 mg/day increments to optimum effect with minimum 1-4 days between dose increments
- Not to exceed 36 mg/day; single doses greater than 16 mg not studied
- To discontinue taper gradually; decrease by 2-4 mg daily
- Creatinine clearance (CrCl) less than 25 mL/minute: Use caution; clearance reduced greater than 50%
- CrCl greater than 25 mL/minute: Not studied; use caution
- Close monitoring of adverse drug reactions (ADRs) (e.g., hypotension); avoid in severe impairment
- Not recommended
- Tizanidine overdose can cause lethargy, drowsiness, confusion, respiratory and cardiac depression, coma, and death.
- Overdose is treated with supportive and symptomatic care, including monitoring of respiratory and cardiac functions. Symptoms of overdose generally resolve within three days after discontinuation of tizanidine.
What drugs interact with tizanidine?
Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.
- Tizanidine has no known severe interactions with other drugs.
- Tizanidine has serious interactions with at least 35 different drugs.
- Tizanidine has moderate interactions with at least 35 different drugs.
- Tizanidine has mild interactions with at least 79 different drugs.
The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.
It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.
Pregnancy and breastfeeding
- There are no adequate and well-controlled studies on the safety of tizanidine use in pregnant women. Tizanidine should be used during pregnancy only if benefits from the drug justify potential risks to the fetus.
- It is not known if tizanidine is present in breast milk. Use tizanidine with caution in nursing mothers because many drugs are excreted in breast milk.
What else should I know about tizanidine?
- Take tizanidine exactly as prescribed. Do not switch between tablets and capsules and do not discontinue abruptly, it can cause rebound hypertension and tachycardia.
- Keep tizanidine safely out of reach of children.
- In case of overdose, seek immediate medical help or contact Poison Control Center.
- Avoid alcohol while on tizanidine therapy; it can have additive effects.
- Avoid activities such as driving or operating heavy machinery while taking tizanidine until it is clear that the drug does not make you dizzy or drowsy.
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Tizanidine is a medication used in the management of muscle spasticity, a condition with high muscle tone and stiffness that leads to pain and impaired mobility. Tizanidine is used to treat chronic neck and/or lower back pain, chronic migraine headaches, rebound headaches, regional musculoskeletal pain syndromes, and refractory insomnia in spastic quadriplegic patients. Common side effects of tizanidine include drowsiness (somnolence), dry mouth (xerostomia), weakness or/and fatigue (asthenia), dizziness, slow heart rate (bradycardia), low blood pressure (hypotension), urinary tract infection, infections, constipation, liver injury, and elevated liver enzymes.
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What Are the Very First Signs of Multiple Sclerosis?
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How Do You Stop a Migraine Without Aura?
While migraines cannot be cured, symptoms can be improved with medications and preventative measures. Learn how to treat migraines without aura.
What Does Hemiplegic Migraine Feel Like?
Symptoms of hemiplegic migraine mimic those of a stroke, and the muscle weakness can feel so severe that it causes temporary paralysis on the affected side of the body.
How Common Are Episodic Migraines?
Episodic migraines are characterized by 1-14 migraine headaches per month and are fairly common, affecting about 14% of the population.
Why Do I Get Constant Migraines?
Constant migraines are known as chronic migraines. These are migraine headaches that last for 15 days or more for three consecutive months. Learn the four common causes and ten possible triggers for constant migraines.
Are Migraine Auras Serious?
Migraine with aura (also called classic migraine) is repeated episodes of headache that occur during or after sensory disturbances (aura or migraine aura). These disturbances may include symptoms such as flashes of light, blind spots, and other vision changes or tingling over the hand or face.
12 Ways to Relieve Back Pain
The 12 ways to relieve back pain include physical therapy, diet, mindfulness and meditation, stretching, lifestyle choices, injection treatments, acupuncture, hot and cold therapies, bed rest, chiropractic therapy, OTC medications, and yoga.
What Is an Episodic Migraine? Causes, Treatment, Symptoms
Migraine attacks are said to be episodic if they occur less than 15 days in a month. Learn the causes, symptoms, and treatment of episodic migraines below.
What Causes Migraines?
A migraine is a complex disorder that involves episodes of recurrent and severe headaches. An episode of a migraine can be very painful, lasting for hours, making day-to-day activities difficult until the episode is resolved. The frequency and severity of migraine attacks tend to decline with age. And women are more likely to suffer from migraines than men.
Alternative Treatment for MS (CAM for MS)
The term alternative therapy, in general, is used to describe any medical treatment or intervention that has not been scientifically documented or identified as safe or effective for a specific condition. Alternative therapy encompasses a variety of disciplines that range from diet and exercise to mental conditioning to lifestyle changes.
What Is Sclerosis in Multiple Sclerosis?
The medical term sclerosis refers to abnormal hardening of body tissue. In multiple sclerosis, there is a development of hard areas called "plaques" along a neuron's axon (part of a nerve cell).
Why Am I Suddenly Getting Ocular Migraines?
Ocular migraines result due to changes in the blood vessels or nerves that supply the eyes. This may occur due to a combination of genetic factors, lifestyle, and environmental conditions.
Are Migraines a Symptom of COVID-19?
Although the main symptoms of COVID-19 are fever, cough, and shortness of breath, migraines are also a common symptom that may persist during or after infection.
Does Alcohol Mess With Multiple Sclerosis?
Studies suggest that consuming alcohol may worsen some symptoms of multiple sclerosis, such as the following.
What Is Middle Back Pain a Symptom Of?
Middle back pain is a common complaint in middle-aged individuals who sit for long hours at work. It is felt between the shoulder blades. The problem may be simply poor posture or something more serious.
How Do You Get Rid of Vestibular Migraines? Triggers, Medications, Symptoms
Getting rid of vestibular migraines involves managing the active episode (acute treatment) and preventing further episodes (prophylactic treatment).
What Is the Difference Between Clinically Isolated Syndrome and Multiple Sclerosis?
Clinically isolated syndrome (CIS) is often considered as a phenotype or phase of multiple sclerosis (MS). The clinical symptoms of both CIS and MS look identical; however, they differ in the following ways.
What Are the Phenotypes of Multiple Sclerosis (MS)?
Phenotypes can be useful for clinical diagnosis by characterizing the most typical patterns of progression identified in MS patients. Learn about the four basic phenotypes of MS.
What Are the First Signs of a Migraine?
The first sign of a migraine is severe eye pain associated with a dull headache. Migraines gradually worsen with physical activity.
How Can I Relieve Back Pain During Pregnancy?
Back pain can happen during pregnancy because your uterus is getting larger and stretching out. Relieve back pain during pregnancy by moving with care and attention, supporting yourself, resting, and strengthening your muscles.
What Could Be the Cause of Upper Back Pain?
There are many potential upper back pain causes. Learn about upper back pain, why upper back pain happens, and how upper back pain is treated.
How Can I Relieve Back Pain at Home?
You can relieve back pain at home with these tips for both short-term and long-term relief.
Why Do Certain Foods Trigger Migraines?
According to recent studies, diet can play a significant role in triggering migraine episodes. Learn about foods you should avoid if you have migraine headaches.
Why Are Menstrual Migraines So Bad? Where Do They Hurt?
Menstrual migraines involve a drop in estrogen levels before your period and an altered pain perception, which results in excruciating headache pain.
Which Are the Pressure Points to Relieve Migraines?
Migraines are complex disorders involving episodes of recurrent and severe headaches. They generally present as a headache on one side and may be associated with visual or sensory symptoms (such as seeing flashes of light, colorful or bright shapes, or hearing sounds of various types) collectively called “aura.”
How Can I Stop Menstrual Migraines?
Menstrual migraines are one type of migraine that tends to strike about 2-3 days before the start of your period. Here are 7 ways to prevent or treat menstrual migraines.
What Are the Best Stretches for Lower Back Pain?
Lower back pain is one of the common types of complaints by the general population. It may happen due to poor posture, injury, stress, or poor sleeping facilities.
What Are the Early Signs of Multiple Sclerosis?
Multiple sclerosis is an autoimmune disease in which the immune system attacks the central nervous system (spinal cord and brain) by damaging and destroying the protective myelin sheath around the nerve fibers. Someone with multiple sclerosis might develop problems with muscle control, vision, bladder control and other body functions.
What Does the Start of a Migraine Feel Like?
Warning signs that a migraine is coming on may include increased urination, constipation, food cravings, mood changes, tiredness, and sensitivity to light or sound.
What are the Best Stretches for Back Pain Relief at Home?
Learn what stretches can help you deal with back pain and manage this condition at home.
How Do You Prevent Migraines When Exercising?
Here are a few tips to help prevent a workout from causing a migraine, such as staying hydrated and sticking to a protein-rich diet.
What Does a Vestibular Migraine Feel Like? Treatment, Triggers
Vestibular migraine is a type of migraine that causes vertigo, as well as dizziness, unsteadiness, or lack of balance.
Is Exercise a Trigger for Migraines?
Vigorous exercise can trigger migraines for some people, possibly due to changes in blood vessel caliber. Here are 8 ways to prevent exercise-induced migraines.
What Is the Best Cure for Migraine?
The best cure for migraine involves preventive medications and lifestyle changes. Some newer medications and therapies are effective in controlling the symptoms of migraine. Avoiding or controlling triggers may provide considerable benefit. Migraine can be prevented mainly by using medications, avoiding triggers and implementing lifestyle changes.
What Foods Trigger Migraines?
Migraine is a chronic neurological disorder that features intense headaches on one or both sides of the head. Migraine attacks may resolve in few hours or may take as long as several days.
How Do You Know If You Have Chronic Migraines?
Chronic migraine is defined by the International Headache Society as 15 or more headache days per month, with at least eight of those days satisfying the migraine criteria.
What Can I Do to Relieve My Back Pain?
Back pain or backache is a common type of pain that may affect any age group depending on the cause.
What Is a High Frequency Migraine?
A patient is diagnosed with high-frequency migraine if they experience 10 to 15 (or more) headache days per month.
What Is the Best Exercise for Back Pain?
We are often a bit negligent toward our back while doing chores or physical exercise. While the causes for back pain may vary, regular exercise and maintaining a healthy weight are crucial for keeping the back healthy.
Percutaneous Musculoskeletal Biopsy
Percutaneous needle technique musculoskeletal biopsy is a procedure to obtain a small piece of tissue (biopsy) from the muscles and/or the bones.
Can Bad Sleeping Habits Cause Migraines?
Bad sleeping habits can cause migraines, as migraine attacks have been linked to the sleep-wake cycle or circadian rhythm. If your sleep-wake cycle is disrupted, it can trigger a migraine.
What Are the Best Exercises for Back Pain?
When you are experiencing back pain, you may want to rest, but being active is good for the back. Exercising can strengthen the muscles of the back and those that support posture, as well as improve overall body health. Strengthening the muscles provides support to the spine and slowly reduces back pain.
How Is Episodic Migraine Treated? Acute, How Long It Lasts
An episodic migraine can last between four hours to three days and may require the following treatment options.
How Should You Sleep to Avoid Migraines?
Migraines can be avoided by practicing good sleep hygiene. Here are 11 tips for improving your sleep habits and preventing headaches.
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