How does tizanidine make you feel?

10 Jun.,2024

 

Tizanidine (Oral Route) Side Effects - Mayo Clinic

Description and Brand Names

Drug information provided by: Merative, Micromedex®

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US Brand Name

  1. Comfort Pac wTizanidine
  2. Zanaflex
  3. Zanaflex Capsule

Descriptions


Tizanidine is used to help relax certain muscles in your body. It relieves spasms, cramping, and tightness of the muscles caused by medical problems, such as multiple sclerosis or certain injuries to the spine. Tizanidine does not cure these problems, but it may allow other treatment, such as physical therapy, to be more helpful in improving your condition.

Tizanidine acts on the central nervous system (CNS) to produce its muscle relaxant effects. Its actions on the CNS may also cause some of the medicine's side effects.

This medicine is available only with your doctor's prescription.

This product is available in the following dosage forms:

  • Tablet
  • Capsule

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of tizanidine in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of tizanidine in the elderly. However, elderly patients are more likely to have kidney problems, which may require caution in patients receiving this medicine.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Ciprofloxacin
  • Fluvoxamine
  • Potassium Citrate
  • Viloxazine

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Adagrasib
  • Alfentanil
  • Alprazolam
  • Amantadine
  • Benzhydrocodone
  • Bromazepam
  • Buprenorphine
  • Butorphanol
  • Calcium Oxybate
  • Cannabidiol
  • Cannabis
  • Capmatinib
  • Carbamazepine
  • Cetirizine
  • Cimetidine
  • Clonazepam
  • Clozapine
  • Codeine
  • Daridorexant
  • Deferasirox
  • Desogestrel
  • Dexmedetomidine
  • Dienogest
  • Dihydroartemisinin
  • Dihydrocodeine
  • Doxylamine
  • Drospirenone
  • Enasidenib
  • Escitalopram
  • Esketamine
  • Estradiol Valerate
  • Ethinyl Estradiol
  • Ethynodiol Diacetate
  • Famotidine
  • Fentanyl
  • Fexinidazole
  • Flibanserin
  • Gabapentin
  • Gabapentin Enacarbil
  • Gestodene
  • Givosiran
  • Glucagon
  • Glycopyrrolate
  • Glycopyrronium Tosylate
  • Hydrocodone
  • Hydromorphone
  • Ketamine
  • Lacosamide
  • Lemborexant
  • Leniolisib
  • LetibotulinumtoxinA-wlbg
  • Levocetirizine
  • Levoketoconazole
  • Levonorgestrel
  • Levorphanol
  • Lofexidine
  • Loxapine
  • Magnesium Oxybate
  • Meperidine
  • Mestranol
  • Methacholine
  • Methadone
  • Methotrexate
  • Metoclopramide
  • Mexiletine
  • Midazolam
  • Morphine
  • Morphine Sulfate Liposome
  • Nalbuphine
  • Norethindrone
  • Norfloxacin
  • Norgestimate
  • Norgestrel
  • Ofloxacin
  • Olanzapine
  • Oliceridine
  • Oxycodone
  • Oxymorphone
  • Pacritinib
  • Peginterferon Alfa-2b
  • Pentazocine
  • Periciazine
  • Phenobarbital
  • Pixantrone
  • Ponesimod
  • Potassium Oxybate
  • Pregabalin
  • Primidone
  • Propafenone
  • Quetiapine
  • Remifentanil
  • Remimazolam
  • Revefenacin
  • Ritlecitinib
  • Rofecoxib
  • Ropeginterferon Alfa-2b-njft
  • Scopolamine
  • Secretin Human
  • Sodium Oxybate
  • Sufentanil
  • Tapentadol
  • Taurursodiol
  • Ticlopidine
  • Tiotropium
  • Tocilizumab
  • Topiramate
  • Tramadol
  • Trazodone
  • Vemurafenib
  • Verapamil
  • Voclosporin
  • Zileuton
  • Zolpidem
  • Zuranolone

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Fosphenytoin
  • Lisinopril
  • Phenytoin

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Tobacco

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Kidney disease or
  • Liver disease&#;Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use

Take this medicine only as directed by your doctor. Do not take more of it and do not take it more often than your doctor ordered. To do so may increase the chance of side effects.

When you take the different dosage forms (tablets, capsules, capsule contents sprinkled over applesauce) of tizanidine with food, it affects the amount of the medicine absorbed into your blood differently. Follow your doctor's instructions for when to take this medicine and whether or not you should take it with food.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage forms (capsules or tablets):
    • For muscle relaxation:
      • Adults&#;At first, 2 milligrams (mg) every 6 to 8 hours. Your doctor may adjust your dose as needed. Do not take more than 36 mg within a 24-hour period.
      • Children&#;Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions

It is important that your doctor check your progress at regular visits, especially during the first few weeks of treatment with this medicine. This will allow your doctor to see if the medicine is working properly and to check for unwanted effects. Blood tests may be needed to check for unwanted effects.

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Do not use this medicine together with ciprofloxacin or fluvoxamine. Using these medicines together may cause serious unwanted effects.

Dizziness, lightheadedness, or fainting may occur when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

This medicine will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are 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 anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are using tizanidine.

This medicine may cause dizziness, drowsiness, lightheadedness, clumsiness or unsteadiness, or vision problems in some people. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert, well-coordinated, and able to see well.

Hallucinations (visual) may occur while you are using this medicine. Check with your doctor right away if you have hallucinations (seeing things that are not there).

This medicine may cause serious allergic reactions, including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Do not suddenly stop taking this medicine without checking first with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping completely. This may help prevent a possible worsening of your condition and reduce the possibility of withdrawal symptoms.

Tizanidine may cause dryness of the mouth. For temporary relief, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if dry mouth continues for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

  1. Chest pain or discomfort
  2. fever or chills
  3. nausea or vomiting
  4. nervousness
  5. pain or burning while urinating
  6. unusual tiredness

Less common

  1. Blurred vision
  2. flu-like symptoms
  3. irregular heartbeat
  4. itching skin
  5. kidney stones
  6. right upper stomach tenderness
  7. seeing things that are not there
  8. shortness of breath
  9. weight gain

Incidence not known

  1. Continuing vomiting
  2. general feeling of tiredness or weakness
  3. headache
  4. light-colored stools

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

  1. Blurred vision
  2. change in consciousness
  3. chest pain or discomfort
  4. confusion
  5. decreased awareness or responsiveness
  6. difficult or troubled breathing
  7. dizziness, faintness or lightheadedness when getting up from a lying position
  8. irregular, fast or slow, or shallow breathing
  9. lightheadedness, dizziness, or fainting
  10. loss of consciousness
  11. pale or blue lips, fingernails, or skin
  12. severe sleepiness
  13. sleepiness or unusual drowsiness
  14. slow or irregular heartbeat
  15. sweating
  16. unusual tiredness or weakness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  1. Dizziness or lightheadedness, especially when getting up from a lying or sitting position
  2. drowsiness
  3. dry mouth
  4. fatigue
  5. sleepiness
  6. weakness

Less common

  1. Constipation
  2. nervousness
  3. sore throat

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-.

Tizanidine: 7 things you should know

  1. Home
  2. Tizanidine
  3. Patient Tips

Tizanidine: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on April 4, .

1. How it works

  • Tizanidine may be used to treat spasticity associated with a brain or spinal injury.
  • Tizanidine works by a central mechanism (this means it acts in the brain) but experts are not sure exactly how it works to reduce muscle tone and spasms, but suggest it may be due to tizanidine increasing presynaptic inhibition of the nerves that supply the muscles. Tizanidine works more on polysynaptic pathways rather than monosynaptic spinal reflexes. Tizanidine relaxes muscles by dampening down nerve impulses that are sent from spasming muscles along nerve fibers to the brain.
  • Tizanidine belongs to the class of medicines known as central alpha-2-adrenergic agonists. It may also be called a centrally-acting muscle relaxant.

2. Upsides

  • May be used to reduce muscle spasms that are associated with cerebral (brain) or spinal injury.
  • May be used alone or together with other treatments for muscle spasms, such as baclofen.
  • Effective at relaxing muscles (reduces muscle spasms).
  • No direct effects on skeletal muscle fibers.
  • May improve pain associated with muscle spasms.
  • May be used on an as-needed basis.
  • Despite being structurally related to clonidine, tizanidine has only 1/10th to 1/50th of clonidine's antihypertensive effect which means it is less likely to lower blood pressure than clonidine.
  • Tizanidine is usually started as a dosage of 2mg to 4mg to minimize the risk of side effects; however, dosages less than 8mg have been shown to be ineffective in clinical trials. The dosage should be increased by 2-4mg daily for 2 to 4 weeks until the best effects are seen.
  • No dosage adjustments are needed for liver disease.
  • Generic tizanidine is available.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Low blood pressure, drowsiness, dizziness, energy loss, and a dry mouth.
  • Has been associated with hallucinations and rarely psychosis in approximately 3% of people.
  • The dosage of tizanidine needs to be individualized according to a person's requirements and response.
  • May not be suitable for people that rely on spasticity to sustain their posture and balance.
  • May cause a drop in blood pressure when going from a sitting or lying down position to standing. This may increase the risk of falls.
  • May affect a person's ability to drive or operate machinery. Alcohol should be avoided.
  • May cause withdrawal symptoms such as high blood pressure and a fast heartbeat if stopped abruptly after regular extended dosing (decrease dose slowly under a doctor's advice). Withdraw tizanidine slowly. Decrease by about 2mg to 4mg per day.
  • Seniors may be more susceptible to the side effects of tizanidine.
  • Tizanidine may cause allergic reactions in some people, such as anaphylaxis and urticaria.
  • May interact with several other drugs including those metabolized by hepatic enzymes CYP1A2 (such as fluvoxamine, ciprofloxacin, and some antiarrhythmics), and oral contraceptives. Alcohol increases the peak concentration of tizanidine and also the likelihood of side effects.
  • Liver enzymes (specifically aminotransferase) should be monitored when starting treatment, when clinically indicated, and for at least one month after the maximum dosage is achieved.
  • The different dosage forms of tizanidine (for example, the tablets vs capsules) and modification of the administration of tizanidine (for example swallowing the capsules whole vs opening them up and sprinkling them on applesauce) may cause clinically important differences in effect, such as more side effects or more rapid onset of activity.
  • Needs to be given every 6 to 8 hours. The maximum single dose is 16mg and the maximum total daily dose is 36mg in 24 hours.
  • The safety and effectiveness of tizanidine has not been established for people aged under 18 years.
  • Lower total daily dosages may be necessary with kidney disease. Increase individual dosages if higher dosages are needed rather than increasing dosage frequency.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Tizanidine relieves muscle spasms but may cause sleepiness, a drop in blood pressure, and sedation. The dosage should be individualized and because it only lasts for a short time in the body, can be taken on an as needed basis. Monitoring of liver enzymes is required.

5. Tips

  • Capsules may be opened and the contents sprinkled on food.
  • Taking with food increases absorption by 20% but slows the time for effect. Can be taken with or without food, but should be dosed consistently (either with or without food).
  • Tizanidine is relatively short-acting; therefore it should be taken at times when relief of spasticity is the most important (such as before activities of daily living).
  • Take tizanidine exactly as directed. Do not increase the dosage without your doctor's advice. Tizanidine tablets and capsules are not directly interchangeable; a dosage adjustment may be necessary (talk with your doctor).
  • Be careful when going from sitting or lying down position to standing as tizanidine may increase your risk of falls. Remove any fall hazards (such as loose rugs) from your home.
  • Seek immediate medical advice if you experience any worrying side effects including hallucinations, fainting, sleepiness, or allergic-type reactions.
  • Do not stop taking tizanidine suddenly without your doctor's advice as high blood pressure and a fast heartbeat may result.
  • Effects are dose-related (the bigger the dose, the stronger the effect, but the more noticeable any side effects are).
  • Tizanidine can make you sleepy. The risk is greater if you also take other drugs, such as benzodiazepines, or sleeping pills. Do not drink any alcohol while taking tizanidine.
  • Do not take any other medication, including medicines brought over-the-counter, in addition to tizanidine, without checking with your doctor or pharmacist to make sure they are compatible.

6. Response and effectiveness

  • The effects of tizanidine peak within 1-2 hours and start to wear off within 3 to 6 hours. Because of this short duration of effect, tizanidine may be dosed on an "as needed" basis during times when muscle spasms are at their most severe.

7. Interactions

Medicines that interact with tizanidine may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with tizanidine. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with tizanidine include:

  • acyclovir
  • amiodarone
  • anti-anxiety medications
  • anticonvulsants
  • antidepressants, such as amitriptyline, imipramine, nortriptyline
  • antihistamines that cause sedation, such as diphenhydramine
  • azelastine
  • chlormethiazole
  • ciprofloxacin
  • dronedarone
  • duloxetine
  • fluvoxamine
  • HIV medications such as saquinavir
  • medications that lower blood pressure, such as ACE inhibitors (eg, enalapril), barbiturates, beta-blockers (such as atenolol), or calcium channel antagonists (such as diltiazem)
  • medicines that inhibit CYP1A2 enzymes such as cimetidine or rifampin
  • metoclopramide
  • opioid analgesics such as oxycodone and morphine
  • other muscle relaxants such as methocarbamol
  • pimozide
  • sleeping pills, such as zolpidem
  • some chemotherapy treatments
  • some medications used to treat mental illness, such as clozapine and thioridazine
  • smoked tobacco
  • treatments for erectile dysfunction, such as sildenafil or tadalafil
  • topiramate
  • zolpidem.

Alcohol may worsen the side effects of tizanidine such as drowsiness and dizziness.

Note that this list is not all-inclusive and includes only common medications that may interact with tizanidine. You should refer to the prescribing information for tizanidine for a complete list of interactions.

References

  • Tizanidine. Revised 03/. NorthStar Rx LLC. https://www.drugs.com/pro/tizanidine.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use tizanidine only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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