tizanidine (Rx)

Brand and Other Names:Zanaflex
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 2mg
  • 4mg

capsule

  • 2mg
  • 4mg
  • 6mg
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Muscle Spasticity

Spasticity associated with multiple sclerosis and spinal cord injury

Initial: 2 mg PO q6-8hr PRN; no more than 3 doses q24hr

Maintenance: Titrate in 2-4 mg/day increments to optimum effect with minimum 1-4 days between dose increments

Not to exceed 36 mg/day; single doses >16 mg not studied

To discontinue taper gradually; decrease by 2-4 mg daily

Dosing Modifications

Renal impairment

  • CrCl <25 mL/min: Use caution; clearance reduced >50%
  • CrCl >25 mL/min: Not studied; use caution

Hepatic impairment

  • Close monitoring of ADRs (eg, hypotension); avoid in severe impairment

Not recommended

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Interactions

Interaction Checker

and tizanidine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Dry mouth (46-50%)

            Somnolence (46-50%)

            Dizziness (16-20%)

            Asthenia (10-45%)

            1-10%

            Blurred vision (3%)

            Constipation (4%)

            Infection (6%)

            LFT abnormalities (3-5%)

            Speech disorder (3%)

            Vomiting (3%)

            Urinary frequency (3%)

            UTI (10%)

            Frequency Not Defined

            Asthenia

            Bradycardia

            Hypotension

            Orthostatic hypotension

            Syncope (rare)

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            Warnings

            Contraindications

            Hypersensitivity

            Concomitant ciprofloxacin or fluvoxamine, or other potent CYP1A2 inhibitors

            Cautions

            Potential for hypotension

            Caution in renal/hepatic impairment

            Women on oral contraceptives

            Hepatotoxicity may occur; monitor aminotransferases prior to and during use

            Sedation may occur (dose related); may potentiate effect of sedative drugs or ethanol

            Visual hallucinations may occur

            CYP1A2 inducers may decrease levels

            Rebound hypertension, tachycardia, and hypertonia reported upon abrupt discontinuation; decrease doses slowly in patients taking concomitant narcotics or high doses (20-28 mg/day) for prolonged periods

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: May be excreted in breast milk due to lipophilic nature; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Alpha-2 adrenergic receptor agonist structurally related to clonidine; increases presynaptic inhibition of motor neurons

            Absorption

            Bioavailability: 40%

            Peak serum time: 1-4 hr

            Distribution

            Protein bound: 30%

            Vd: 2.4 L/kg

            Metabolism

            Extensively metabolized in the liver

            Elimination

            Half-life: 2.5 hr

            Excretion: Feces (20%); urine (60%)

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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