Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Medical prescription wikipedia , lookup
Compounding wikipedia , lookup
Pharmaceutical industry wikipedia , lookup
Pharmaceutical marketing wikipedia , lookup
Drug interaction wikipedia , lookup
List of off-label promotion pharmaceutical settlements wikipedia , lookup
Psychopharmacology wikipedia , lookup
Intravenous therapy wikipedia , lookup
Electronic prescribing wikipedia , lookup
Disclaimer: This is for informational purposes only. This does not replace the instructions you received from Dr. Anderson or any other practitioner, constitute medical treatment, establishment of a patient-physician relationship, constitute any form of recommendation, prescription or medical advice, or imply that the medication is appropriate or FDA approved for any condition. This information may be outdated and is not a complete listing of instructions, doses, uses, or side effects. If this was prescribed to you, you must review this information with your pharmacist and prescriber before starting the medication. Any medication may interfere with the ability to drive, concentrate, or operate machinery; patients must be responsible for their own behavior and should not engage in any dangerous activity if there is any question of impairment. All medications have side effects and drug interactions, some serious, some fatal. Let all of your practitioners and pharmacist know about every substance used. Alcohol, herbals, or illegal drugs are not considered safe with these medications. Assume no medication is safe during pregnancy or while breast feeding. The medication may interfere with birth control. Almost any medication can cause sleepiness, insomnia, dizziness, confusion, hallucinations, anxiety, panic, constipation or diarrhea, headache, chest pain and nausea or vomiting, among others. These could cause physical injury, such as dizziness causing one to fall down stairs. Many reduce blood pressure, which could cause fainting, dizziness, stroke, or other problems. Most medications should NOT be stopped suddenly because of the risk of withdrawal. This is a supplement to the standardized drug information sheets. Drug: CYCLOBENZAPRINE Wayne E. Anderson, D.O. A Medical Corporation FDA-approved uses: The medication is FDA approved for shortterm use as adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions. Common off-label uses: Chronic musculoskeletal pain, muscular pain associated with poor sleep, fibromyalgia, myofascial pain. Chronic Intractable Pain Disorders Headache & Facial Pain Disorders Neurotoxin Therapy Alternatives: Non-medication modalities, pain interventions and other medications that may work in a similar manner. How it works: Many drugs do not have an established mechanism of action. This drug was originally introduced as a sort-of tricyclic antidepressant but was found to work better as a muscle relaxant. The exact reason why it works as a muscle relaxant is not known but the major mechanism of action likely occurs in the brainstem. Board Certified Neurology American Board of Psychiatry & Neurology Board Certified Pain Medicine American Board of Psychiatry & Neurology in association with the American Board of Anesthesiology Subspecialty Certified Headache Medicine United Council for Neurological Subspecialties Qualified Medical Evaluator Member of the California Pacific Neuroscience Institute Side effects: Please see the standardized drug information sheet for detailed information about risks, side effects, interactions, and other important information. There are two forms of the medication, the regular release (short-acting) product Flexeril and the long-acting (24-hour) product Amrix, plus the generics. Although the medication is FDA approved for up to 14 days’ use, it is not uncommon to use the medication for longer periods; safety and efficacy are not established after two weeks. Cyclobenzaprine is metabolized by the liver and kidney; it should not be used in patients with impaired liver function. Because cyclobenzaprine may have some tricyclic antidepressant activity, there is an increased risk of seizure when used with tramadol (Ultram/Ultracet), which also may have similar activity. Common doses: The long-acting form has the brand name Amrix. This medication is perhaps stronger when taken with food. It comes as 15mg or 30mg per day, taken once daily around dinnertime. It is intended to last 24 hours. It is intended to be used at 6-7pm and not in the morning. The more-common short-acting form has the brand name Flexeril. This medication is taken up to three times daily as 5mg or 10mg. The 10mg size has the potential to be more sedating (sleep causing) than the 5mg size. 45 Castro Street Suite 225 San Francisco CA 94114 415.558.8584 tel 415.513.4521 fax www.wayneanderson.net Time to effect: This medication tends to provide benefit relatively quickly, usually within a few days. Financial: Dr. Anderson has never received payment in exchange for prescribing a medication. Dr. Anderson has no financial relationship with the companies that manufacture Flexeril or generic cyclobenzaprine. Dr. Anderson, in the past, provided medical education lectures compensated by the manufacturer of Amrix. Should patients not wish to receive a medication made by a pharmaceutical company of which Dr. Anderson is or was a consultant, alternatives will be discussed. Insurance coverage: Many medications, especially in painful conditions, are off-label as discussed above. Insurance companies do not need to cover medications used off label but typically do provide coverage for most medications that have good scientific evidence. There is no guarantee that any medication will be covered. Very often, the medications in this category are covered for 14 days only. Clinical and Scientific evidence: Some scientific evidence supportive of the use of the medication is listed in this section. Of course, scientific information changes rapidly and the information listed may become outdated or incorrect overnight. Cyclobenzaprine has evidence supportive of use in chronic pain syndromes. Cyclobenzaprine has peer reviewed evidential support for use in fibromyalgia type neuropathic chronic pain syndromes. Cyclobenzaprine has a structure similar to TCAs and is not FDA approved for fibromyalgia or neuropathic pain but is considered a first-line agent for fibromyalgia type pain syndromes. In other studies, it has been found to improve sleep and reduce tenderness, stiffness, and fatigue at up to 20mg per day, with grade B evidence of efficacy. References: 1. Kroenke K, Krebs EE, Bair MJ. Gen Hosp Psychiatry. 2009 May-Jun;31(3):206-19. Pharmacotherapy of chronic pain: a synthesis of recommendations from systematic reviews. 2. Argoff CE. J Am Osteopath Assoc. 2002 Sep;102(9 Suppl 3):S21-7. Pharmacologic management of chronic pain. 3. Lofland JH, Szarlej D, Buttaro T, Shermock S, Jalali S. Clin J Pain. 2001 Mar;17(1):103-4. Cyclobenzaprine hydrochloride is a commonly prescribed centrally acting muscle relaxant, which is structurally similar to tricyclic antidepressants (TCAs) and differs from amitriptyline by only one double bond. 4. Buckhardt CS, Goldenberg D, Crofford L, Gerwin R, Gowens S, Jackson K, Kugel P, McCarberg W, Rudin N, Schanberg L, Taylor AG, Taylor J, Turk D. Guideline for the management of fibromyalgia syndrome pain in adults and children. Glenview (IL): American Pain Society (APS); 2005. Also at National Guideline Clearinghouse as Guideline for the management of fibromyalgia syndrome pain in adults and children. 5. Management of fibromyalgia syndrome in adults. National Guideline Clearinghouse, Dept of Health and Human Services.