Flexeril: Effective Relief for Acute Muscle Spasms
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Flexeril (cyclobenzaprine hydrochloride) is a centrally acting skeletal muscle relaxant indicated as an adjunct to rest and physical therapy for the relief of muscle spasm associated with acute, painful musculoskeletal conditions. It works by acting on the central nervous system to reduce muscle hyperactivity without directly affecting skeletal muscle fibers. Clinical studies demonstrate its efficacy in improving mobility and reducing pain associated with acute musculoskeletal conditions, making it a valuable component in short-term management protocols. Proper diagnosis and supervision by a healthcare professional are essential for appropriate use.
Features
- Active ingredient: Cyclobenzaprine hydrochloride
- Available in 5mg and 10mg oral tablets
- Typically prescribed for short-term use (up to 2-3 weeks)
- Onset of action: Generally within one hour
- Half-life: Approximately 18 hours (with variation among individuals)
- Metabolism: Primarily hepatic via CYP3A4 and CYP1A2 enzymes
- Excretion: Primarily renal
Benefits
- Rapid relief from acute muscle spasm and associated pain
- Improved range of motion during recovery
- Adjunctive therapy that enhances the effectiveness of physical therapy
- Reduces muscle stiffness and hypertonicity
- Helps break the pain-spasm cycle in acute musculoskeletal conditions
- Short-term use minimizes long-term dependency concerns
Common use
Flexeril is primarily prescribed for the short-term management of muscle spasms associated with acute, painful musculoskeletal conditions. These may include acute muscle strains, sprains, or other traumatic injuries to the muscular system. It is commonly used following whiplash injuries, lower back pain episodes, and post-surgical muscle spasm. The medication is typically employed as part of a comprehensive treatment plan that includes rest, physical therapy, and other pain management strategies. It is not indicated for chronic muscle spasm conditions or spasticity associated with cerebral or spinal cord diseases.
Dosage and direction
The recommended adult dosage is 5-10 mg three times daily. The dosage may be adjusted based on individual response and tolerance, with the maximum recommended dose being 30 mg daily (10 mg three times daily). Tablets should be swallowed whole with water and may be taken with or without food. Use should be limited to two or three weeks due to insufficient evidence of effectiveness for longer periods and because muscle spasm associated with acute musculoskeletal conditions is generally of short duration. Elderly patients and those with hepatic impairment may require lower dosing (5 mg initially) due to potentially increased plasma concentrations.
Precautions
Patients should be cautioned about engaging in activities requiring mental alertness, such as operating machinery or driving, as Flexeril may cause drowsiness. Concurrent use with alcohol or other CNS depressants may enhance this effect. Use with caution in patients with mild to moderate hepatic impairment; contraindicated in severe impairment. May enhance the effects of alcohol, barbiturates, and other CNS depressants. Abrupt discontinuation after prolonged use may produce withdrawal symptoms. Not recommended for patients with arrhythmias, heart block, conduction disturbances, or congestive heart failure. Use during pregnancy only if clearly needed, as safety has not been established.
Contraindications
Flexeril is contraindicated in patients hypersensitive to cyclobenzaprine hydrochloride or any component of the formulation. Concurrent use with monoamine oxidase (MAO) inhibitors or within 14 days of their discontinuation. Hyperpyretic crisis, severe convulsions, and deaths have occurred in patients receiving cyclobenzaprine concomitantly with MAO inhibitors. Contraindicated in patients during the acute recovery phase of myocardial infarction, and in those with arrhythmias, heart block or conduction disturbances, or congestive heart failure. Contraindicated in hyperthyroidism.
Possible side effect
Common side effects (≥3%) include drowsiness (29-39%), dry mouth (21-32%), dizziness (6-11%), and fatigue (6%). Less common side effects may include nausea, dyspepsia, constipation, blurred vision, headache, nervousness, and confusion. Rare but serious adverse effects may include tachycardia, arrhythmias, syncope, seizures, hepatitis, and allergic reactions including anaphylaxis. Elderly patients may be more susceptible to side effects, particularly confusion, hallucinations, and syncope. Patients should report any persistent or severe side effects to their healthcare provider promptly.
Drug interaction
Significant interactions occur with MAO inhibitors (contraindicated). Enhanced CNS depression when used with alcohol, barbiturates, benzodiazepines, or other sedatives. May have additive effects with anticholinergic drugs. CYP3A4 inhibitors (ketoconazole, erythromycin) may increase cyclobenzaprine concentrations. Tramadol may increase seizure risk when combined with cyclobenzaprine. Use with tricyclic antidepressants may increase the risk of serotonin syndrome. May potentiate the effects of norepinephrine. Careful monitoring is required when used with other drugs that prolong the QT interval.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. Consistent dosing is important for maintaining therapeutic effect, but occasional missed doses are unlikely to significantly impact treatment efficacy given the drug’s relatively long half-life.
Overdose
Overdose may manifest as severe drowsiness, tachycardia, tremor, agitation, confusion, hallucinations, and cardiac arrhythmias. Severe overdose may lead to coma, convulsions, and cardiac arrest. Management includes gastric lavage if presented early, followed by activated charcoal. Treatment is primarily supportive and symptomatic, with careful cardiac monitoring. Physostigmine may be considered for life-threatening central anticholinergic effects. Dialysis is unlikely to be beneficial due to high protein binding. Contact poison control center immediately for guidance.
Storage
Store at controlled room temperature (20-25°C or 68-77°F). Protect from light and moisture. Keep in the original container with the lid tightly closed. Do not store in bathroom cabinets where humidity may affect stability. Keep out of reach of children and pets. Properly dispose of any expired or unused medication according to local regulations, typically through medication take-back programs.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Flexeril is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual response to medication may vary. Always follow your healthcare provider’s instructions regarding dosage, administration, and duration of treatment. Do not adjust your dosage without consulting your physician. Report any adverse effects to your healthcare provider promptly.
Reviews
Clinical studies demonstrate that Flexeril provides statistically significant relief of muscle spasm compared to placebo when used as part of a comprehensive treatment program. Patients typically report improvement in mobility and reduction in pain within the first few days of treatment. Many healthcare providers consider it an effective option for short-term management of acute musculoskeletal conditions. Some patients report drowsiness as a limiting factor, particularly during the initial days of treatment. Overall satisfaction is generally high when used appropriately for indicated conditions under medical supervision.