How Do the Muscle Relaxers Tizanidine and Cyclobenzaprine Differ?
Medically reviewed by Lindsay Cook, PharmDMedically reviewed by Lindsay Cook, PharmDMuscle relaxers are prescription medications that are often used to treat discomfort associated with muscle spasms, strains, and other muscle and skeletal conditions. However, they are not considered first-line therapies for these conditions and are generally not intended for long-term use.Tizanidine and cyclobenzaprine are two commonly used muscle relaxers. While they are both effective and treat similar conditions, they have features and distinct properties that set them apart.This article will explore what you need to know about how the muscle relaxers tizanidine and cyclobenzaprine are alike and different, as well as the benefits and potential side effects of each.
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Key Similarities
Key Differences
Are muscle relaxers
Have distinct mechanisms of action and different indications (why they are prescribed)
May benefit patients with insomnia caused by severe muscle spasms due to their sedative properties
Vary in safety during pregnancy
Can cause dizziness, drowsiness, and stomach upset
Have different recommended durations of use
Are available in multiple doses
Different age restrictions
Are not considered controlled substances
Varying levels of sedation
What Is Tizanidine?Tizanidine, which is often sold under the brand name Zanaflex, is a short-acting muscle relaxer. It is approved by the Food and Drug Administration (FDA) to manage spasticity (characterized by muscle tightening or stiffness) in adults. Spasticity is often associated with other health conditions, such as multiple sclerosis (MS), cerebral palsy, stroke, and spinal cord injury. Tizanidine is not ideal for back or neck pain.Tizanidine is an alpha-2 adrenergic agonist. It reduces pain and spasms by preventing nerve signals in the central nervous system, including the brain and spinal cord, from transmitting to the muscles. Its effects are temporary because it is short-acting and does not last long in the body. Treatment should be used as needed for symptom relief.This medication is available in tablet and capsule forms. The recommended starting dose is 2 milligrams (mg) every six to eight hours, with a maximum of three doses allowed in 24 hours.Tizanidine should be avoided if you are taking any of the following medications:Fluoroquinolones (ciprofloxacin)Arrhythmia medications such as Nexterone (amiodarone)Pepcid (famotidine)Oral contraceptives (birth control)Zovirax (acyclovir)Benefits of TizanidineAdvantages of taking tizanidine include:Availability as a generic (nonbrand)Effective muscle spasm and stiffness reductionFlexible dosing optionsLess sedatingSide Effects of TizanidineThe most common side effects associated with tizanidine use are:Dry mouthDrowsinessLow energyDizzinessUrinary tract infection (UTI)ConstipationAbnormal liver function labsVomitingYou should also monitor for low blood pressure, especially if taking blood pressure–lowering medication simultaneously.Talk to your healthcare provider about stopping tizanidine if you experience hallucinations. Avoid using tizanidine with alcohol or other central nervous system (CNS) depressants, such as benzodiazepines and opioids.What Is Cyclobenzaprine?Cyclobenzaprine, which is sold under the brand name Amrix, is also a short-acting muscle relaxer. The FDA has approved it to treat muscle spasms associated with painful musculoskeletal conditions in adults and children 15 years or older. It is also used for rest and physical therapy.Immediate-release cyclobenzaprine has been used off-label—that is, for a condition or at a dosage level that differs from what the FDA approved it for—to treat fibromyalgia, which is chronic and widespread muscle pain, in adults. However, it is not FDA-approved for this use, and clinical trials have not proven it to be safe or effective for this indication.Cyclobenzaprine is available in the form of immediate-release tablets and extended-release capsules. The recommended starting dose for cyclobenzaprine tablets is 5 mg up to three times daily, and for cyclobenzaprine capsules, it is usually 15 mg once daily. Treatment duration is recommended to be two to three weeks at most.Cyclobenzaprine should not be taken with or within 14 days after stopping a monoamine oxidase inhibitor (MAOI), such as Marplan (isocarboxazid), Nardil (phenelzine), or Emsam (selegiline), due to the risk of severe side effects.Cyclobenzaprine use should be avoided if you are taking any of the following medications:Ultram (tramadol)SSRIs, Celexa (citalopram), Lexapro (escitalopram), Prozac (fluoxetine), and Zoloft (sertraline)SNRIs (such as Cymbalta and Effexor)Tricyclic antidepressant, Elavil (amitriptyline)Wellbutrin (bupropion)Verelan (verapamil)Be sure your healthcare provider is aware of all supplements, prescription, or over-the-counter medications you take. If treatment with cyclobenzaprine and another medication that poses a potential interaction risk is necessary, notify your healthcare provider of any side effects you experience.Benefits of CyclobenzaprineBenefits of cyclobenzaprine use include:Generic form availableSafe in pregnancyCan be sprinkled on applesauceAvailable in immediate-release and extended-release formulationsCan be used by people with kidney issuesMay be helpful in patients with low-back painTaken with or without foodSide Effects of CyclobenzaprineThe most common side effects associated with cyclobenzaprine use are:Stomach painAcid refluxConstipationDiarrheaDizzinessNauseaNervousnessRespiratory infectionAvoid using cyclobenzaprine with alcohol or other CNS depressants, such as benzodiazepines and opioids.Use with caution if you have a history of urinary retention, angle-closure glaucoma, increased intraocular pressure, or if you are taking an anticholinergic medication (used to manage brain, bladder, and digestive conditions), such as Benadryl (diphenhydramine) or Oxytrol (oxybutynin).Cyclobenzaprine should not be used if you have a history of hyperthyroidism (overactive thyroid) or certain heart conditions, such as arrhythmia (irregular heartbeat) or congestive heart failure (syndrome that results in decreased blood supply to the body).Preventing Side EffectsIt is important to monitor the potential side effects of tizanidine and cyclobenzaprine clearly. Side effects are also an important factor to consider when determining which medication is best for you.Consider doing the following to lower your risk of experiencing side effects associated with tizanidine or cyclobenzaprine use:Start with the lowest tolerated dose of the medication and work with your provider to adjust your dose as needed.Take the medication exactly as prescribed.Adhere to dosing instructions, for example, taking with or without food as instructed.Do not suddenly discontinue the medication.Inform your healthcare provider if you are taking other medications to prevent drug interactions.Avoid using these drugs with alcohol or other sedating medications.Consult with your healthcare provider regarding any side effect concerns and seek your provider's advice before stopping the medication.Tizanidine vs. Cyclobenzaprine: Differences and SimilaritiesSome of the main similarities and differences between tizanidine and cyclobenzaprine are:SummaryMuscle relaxers are prescription medications often used to treat discomfort associated with muscle spasms, strains, and other muscle and skeletal conditions. Tizanidine and cyclobenzaprine are two effective, commonly used muscle relaxers. They work differently but also have some similarities.These medications have similar side effects and interact with a variety of medications. There is no clinical research to suggest that one medication is better than the other. Choosing a muscle relaxer should be based on individual medication characteristics and your specific situation. Read the original article on Verywell Health.
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