Download Drug: CYCLOBENZAPRINE

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 This information may be outdated and is not a complete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.