cyclobenzaprine (Rx)

Brand and Other Names:Flexeril, Amrix, more...Fexmid
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 5mg
  • 7.5mg
  • 10mg

capsule, extended-release

  • 15mg
  • 30mg

Muscle Spasm

Immediate-release tablet

  • 5 mg PO q8hr; may increase dose to 7.5-10 mg PO q8hr PRN

Extended-release capsule

  • 15 mg PO qDay; some patients may require up to 30 mg PO qDay

Dosing Modifications

Hepatic impairment

  • Immediate-release tablet: 5 mg/day PO initially; titrate slowly and consider less frequent dosing
  • Extended-release capsule: Not recommended in mild-to-severe hepatic impairment

Renal Impairment

  • Not studied

Dosage Forms & Strengths

tablet

  • 5mg
  • 7.5mg
  • 10mg

Muscle Spasm

Immediate-release tablet

  • <15 years: Safety and efficacy not established
  • >15 years: 5 mg PO q8hr; may increase dose to 7.5-10 mg PO q8hr PRN

Extended-release capsule

  • <18 years: Safety and efficacy not established
  • >18 years: 15 mg PO qDay; some patients may require up to 30 mg PO qDay

Muscle Spasm

Immediate-release tablet: 5 mg/day PO initially; titrate slowly upward and consider less frequent dosing

Extended-release capsule not recommended in elderly, because of increased plasma levels (40%) and prolonged half-life (56%) compared with young adults

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Interactions

Interaction Checker

and cyclobenzaprine

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            Contraindicated (4)

            • isocarboxazid

              isocarboxazid and cyclobenzaprine both increase serotonin levels. Contraindicated. Do not coadminister cyclobenzaprine with MAOIs or within 14 days of discontinuing an MAOI

            • phenelzine

              phenelzine and cyclobenzaprine both increase serotonin levels. Contraindicated. Do not coadminister cyclobenzaprine with MAOIs or within 14 days of discontinuing an MAOI

            • safinamide

              cyclobenzaprine, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.

            • tranylcypromine

              tranylcypromine and cyclobenzaprine both increase serotonin levels. Contraindicated. Do not coadminister cyclobenzaprine with MAOIs or within 14 days of discontinuing an MAOI

            Serious - Use Alternative (50)

            • abametapir

              abametapir will increase the level or effect of cyclobenzaprine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP1A2 substrates. If not feasible, avoid use of abametapir.

            • almotriptan

              almotriptan and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • amitriptyline

              amitriptyline and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • amoxapine

              amoxapine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen, cyclobenzaprine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • bupropion

              bupropion and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • calcium/magnesium/potassium/sodium oxybates

              cyclobenzaprine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • citalopram

              citalopram and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • clomipramine

              clomipramine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • desipramine

              desipramine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • desvenlafaxine

              desvenlafaxine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • doxepin

              doxepin and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • duloxetine

              duloxetine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • eletriptan

              eletriptan and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • escitalopram

              escitalopram and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • fluoxetine

              fluoxetine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • fluvoxamine

              fluvoxamine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • frovatriptan

              frovatriptan and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • givosiran

              givosiran will increase the level or effect of cyclobenzaprine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP1A2 substrates with givosiran. If unavoidable, decrease the CYP1A2 substrate dosage in accordance with approved product labeling.

            • hydrocodone

              hydrocodone, cyclobenzaprine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • imipramine

              imipramine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • levomilnacipran

              levomilnacipran and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • linezolid

              linezolid and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first

            • meperidine

              meperidine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • methylene blue

              methylene blue and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first

            • metoclopramide intranasal

              cyclobenzaprine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            • milnacipran

              milnacipran and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • mirtazapine

              mirtazapine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • naratriptan

              naratriptan and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • nefazodone

              nefazodone and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • nortriptyline

              nortriptyline and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • paroxetine

              paroxetine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • pramlintide

              pramlintide, cyclobenzaprine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

            • protriptyline

              protriptyline and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • rizatriptan

              rizatriptan and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • sertraline

              sertraline and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • sodium oxybate

              cyclobenzaprine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • sufentanil SL

              sufentanil SL, cyclobenzaprine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • sumatriptan

              sumatriptan and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • sumatriptan intranasal

              sumatriptan intranasal and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • tedizolid

              tedizolid, cyclobenzaprine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

            • tramadol

              tramadol and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • trazodone

              trazodone and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • trimipramine

              trimipramine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • vandetanib

              cyclobenzaprine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

            • venlafaxine

              venlafaxine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • verapamil

              verapamil and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • vilazodone

              vilazodone and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • vortioxetine

              cyclobenzaprine, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

            • zolmitriptan

              zolmitriptan and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            Monitor Closely (216)

            • abobotulinumtoxinA

              cyclobenzaprine increases effects of abobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Muscle relaxants may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

            • aclidinium

              cyclobenzaprine and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • alfentanil

              cyclobenzaprine and alfentanil both increase sedation. Use Caution/Monitor.

            • alprazolam

              alprazolam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • amantadine

              cyclobenzaprine, amantadine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Potential for increased anticholinergic adverse effects.

            • amitriptyline

              cyclobenzaprine and amitriptyline both increase sedation. Use Caution/Monitor.

            • amobarbital

              amobarbital and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • amoxapine

              cyclobenzaprine and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclobenzaprine and amoxapine both increase sedation. Use Caution/Monitor.

            • anticholinergic/sedative combos

              anticholinergic/sedative combos and cyclobenzaprine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • apomorphine

              cyclobenzaprine and apomorphine both increase sedation. Use Caution/Monitor.

            • aripiprazole

              cyclobenzaprine and aripiprazole both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of aripiprazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              aripiprazole increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • atracurium

              atracurium and cyclobenzaprine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • atropine

              atropine and cyclobenzaprine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • atropine IV/IM

              atropine IV/IM and cyclobenzaprine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • azelastine

              azelastine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • baclofen

              baclofen and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • belladonna alkaloids

              belladonna alkaloids and cyclobenzaprine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • belladonna and opium

              cyclobenzaprine and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclobenzaprine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • benperidol

              cyclobenzaprine and benperidol both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of benperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of benperidol by pharmacodynamic antagonism. Use Caution/Monitor.

              benperidol increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • benzphetamine

              cyclobenzaprine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • benztropine

              benztropine and cyclobenzaprine both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use.

            • bethanechol

              bethanechol increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • brexanolone

              brexanolone, cyclobenzaprine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • brompheniramine

              brompheniramine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • buprenorphine

              cyclobenzaprine and buprenorphine both increase sedation. Use Caution/Monitor.

            • buprenorphine buccal

              cyclobenzaprine and buprenorphine buccal both increase sedation. Use Caution/Monitor.

            • buprenorphine subdermal implant

              cyclobenzaprine, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

            • buprenorphine, long-acting injection

              cyclobenzaprine, buprenorphine, long-acting injection. Either increases toxicity of the other by serum potassium. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

              buprenorphine, long-acting injection increases effects of cyclobenzaprine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Buprenorphine may enhance the neuromuscular blocking action of skeletal muscle relaxants and increase risk for respiratory depression. Monitor for signs of respiratory depression that may be greater than otherwise expected and decrease muscle relaxant dosage as necessary.

            • butabarbital

              butabarbital and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • butalbital

              butalbital and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • butorphanol

              cyclobenzaprine and butorphanol both increase sedation. Use Caution/Monitor.

            • cannabidiol

              cannabidiol, cyclobenzaprine. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Owing to the potential for both CYP1A2 induction and inhibition with the coadministration of CYP1A2 substrates and cannabidiol, consider reducing dosage adjustment of CYP1A2 substrates as clinically appropriate.

            • carbachol

              carbachol increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • carisoprodol

              carisoprodol and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • cenobamate

              cenobamate, cyclobenzaprine. Either increases effects of the other by sedation. Use Caution/Monitor.

            • cevimeline

              cevimeline increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chloral hydrate

              chloral hydrate and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              cyclobenzaprine and chlorpromazine both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor.

              chlorpromazine increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • cinnarizine

              cinnarizine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • cisatracurium

              cisatracurium and cyclobenzaprine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • citalopram

              cyclobenzaprine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • clemastine

              clemastine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • clobazam

              cyclobenzaprine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

            • clomipramine

              cyclobenzaprine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclobenzaprine and clomipramine both increase sedation. Use Caution/Monitor.

            • clonazepam

              clonazepam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • clorazepate

              clorazepate and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • clozapine

              cyclobenzaprine and clozapine both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.

              clozapine increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • codeine

              cyclobenzaprine and codeine both increase sedation. Use Caution/Monitor.

            • crizotinib

              crizotinib and cyclobenzaprine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • cyclizine

              cyclizine and cyclobenzaprine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclizine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • dantrolene

              cyclobenzaprine and dantrolene both increase sedation. Use Caution/Monitor.

            • darifenacin

              cyclobenzaprine and darifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • deferasirox

              deferasirox will increase the level or effect of cyclobenzaprine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

            • desipramine

              cyclobenzaprine and desipramine both increase sedation. Use Caution/Monitor.

            • dexchlorpheniramine

              dexchlorpheniramine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • dexfenfluramine

              cyclobenzaprine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmedetomidine

              dexmedetomidine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • dextromoramide

              cyclobenzaprine and dextromoramide both increase sedation. Use Caution/Monitor.

            • diamorphine

              cyclobenzaprine and diamorphine both increase sedation. Use Caution/Monitor.

            • diazepam

              diazepam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • diazepam intranasal

              diazepam intranasal, cyclobenzaprine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

            • dicyclomine

              cyclobenzaprine and dicyclomine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • difenoxin hcl

              cyclobenzaprine and difenoxin hcl both increase sedation. Use Caution/Monitor.

            • dimenhydrinate

              dimenhydrinate and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              cyclobenzaprine and diphenhydramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              diphenhydramine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • diphenoxylate hcl

              cyclobenzaprine and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

            • dipipanone

              cyclobenzaprine and dipipanone both increase sedation. Use Caution/Monitor.

            • donepezil

              donepezil increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopexamine

              cyclobenzaprine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dosulepin

              cyclobenzaprine and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclobenzaprine and dosulepin both increase sedation. Use Caution/Monitor.

            • doxepin

              cyclobenzaprine and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclobenzaprine and doxepin both increase sedation. Use Caution/Monitor.

            • doxylamine

              doxylamine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • droperidol

              cyclobenzaprine and droperidol both increase sedation. Use Caution/Monitor.

              droperidol, cyclobenzaprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of V tach, fibrillation.

              cyclobenzaprine decreases levels of droperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of droperidol by pharmacodynamic antagonism. Use Caution/Monitor.

              droperidol increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • echothiophate iodide

              echothiophate iodide increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • esketamine intranasal

              esketamine intranasal, cyclobenzaprine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

            • estazolam

              estazolam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • ethanol

              cyclobenzaprine and ethanol both increase sedation. Use Caution/Monitor.

            • etomidate

              etomidate and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • fenfluramine

              cyclobenzaprine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fesoterodine

              cyclobenzaprine and fesoterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • fexinidazole

              fexinidazole will increase the level or effect of cyclobenzaprine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

            • flavoxate

              cyclobenzaprine and flavoxate both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • fluphenazine

              cyclobenzaprine and fluphenazine both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of fluphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of fluphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

              fluphenazine increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • flurazepam

              flurazepam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • galantamine

              galantamine increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • glycopyrrolate

              cyclobenzaprine and glycopyrrolate both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • glycopyrrolate inhaled

              cyclobenzaprine and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • haloperidol

              cyclobenzaprine and haloperidol both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of haloperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of haloperidol by pharmacodynamic antagonism. Use Caution/Monitor.

              haloperidol increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • homatropine

              cyclobenzaprine and homatropine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • huperzine A

              huperzine A increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hydromorphone

              cyclobenzaprine and hydromorphone both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • hyoscyamine

              cyclobenzaprine and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • hyoscyamine spray

              cyclobenzaprine and hyoscyamine spray both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • iloperidone

              cyclobenzaprine and iloperidone both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of iloperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of iloperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              iloperidone increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • imipramine

              cyclobenzaprine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclobenzaprine and imipramine both increase sedation. Use Caution/Monitor.

            • incobotulinumtoxinA

              cyclobenzaprine, incobotulinumtoxinA. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Muscle relaxants may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

            • indacaterol, inhaled

              indacaterol, inhaled, cyclobenzaprine. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

            • ipratropium

              cyclobenzaprine and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • ketamine

              ketamine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • ketotifen, ophthalmic

              cyclobenzaprine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

            • lasmiditan

              lasmiditan, cyclobenzaprine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

            • lemborexant

              lemborexant, cyclobenzaprine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

            • levorphanol

              cyclobenzaprine and levorphanol both increase sedation. Use Caution/Monitor.

            • lofepramine

              cyclobenzaprine and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclobenzaprine and lofepramine both increase sedation. Use Caution/Monitor.

            • lofexidine

              cyclobenzaprine and lofexidine both increase sedation. Use Caution/Monitor.

            • loprazolam

              loprazolam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • lorazepam

              lorazepam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • lormetazepam

              lormetazepam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • loxapine

              cyclobenzaprine and loxapine both increase sedation. Use Caution/Monitor.

            • loxapine inhaled

              loxapine inhaled increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              cyclobenzaprine and loxapine inhaled both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.

            • lurasidone

              lurasidone, cyclobenzaprine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

            • maprotiline

              cyclobenzaprine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclobenzaprine and maprotiline both increase sedation. Use Caution/Monitor.

            • marijuana

              cyclobenzaprine and marijuana both increase sedation. Use Caution/Monitor.

            • meclizine

              cyclobenzaprine and meclizine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • melatonin

              cyclobenzaprine and melatonin both increase sedation. Use Caution/Monitor.

            • meperidine

              cyclobenzaprine and meperidine both increase sedation. Use Caution/Monitor.

            • meprobamate

              cyclobenzaprine and meprobamate both increase sedation. Use Caution/Monitor.

            • metaxalone

              cyclobenzaprine and metaxalone both increase sedation. Use Caution/Monitor.

            • methadone

              cyclobenzaprine and methadone both increase sedation. Use Caution/Monitor.

            • methocarbamol

              cyclobenzaprine and methocarbamol both increase sedation. Use Caution/Monitor.

            • methscopolamine

              cyclobenzaprine and methscopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              cyclobenzaprine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • midazolam

              midazolam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • midazolam intranasal

              midazolam intranasal, cyclobenzaprine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

            • mirtazapine

              cyclobenzaprine and mirtazapine both increase sedation. Use Caution/Monitor.

            • morphine

              cyclobenzaprine and morphine both increase sedation. Use Caution/Monitor.

            • motherwort

              cyclobenzaprine and motherwort both increase sedation. Use Caution/Monitor.

            • moxonidine

              cyclobenzaprine and moxonidine both increase sedation. Use Caution/Monitor.

            • nabilone

              cyclobenzaprine and nabilone both increase sedation. Use Caution/Monitor.

            • nalbuphine

              cyclobenzaprine and nalbuphine both increase sedation. Use Caution/Monitor.

            • neostigmine

              neostigmine increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nortriptyline

              cyclobenzaprine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclobenzaprine and nortriptyline both increase sedation. Use Caution/Monitor.

            • olanzapine

              cyclobenzaprine and olanzapine both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor.

              olanzapine increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • oliceridine

              oliceridine, cyclobenzaprine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              cyclobenzaprine increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.

            • olodaterol inhaled

              cyclobenzaprine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

            • ombitasvir/paritaprevir/ritonavir & dasabuvir

              ombitasvir/paritaprevir/ritonavir & dasabuvir decreases effects of cyclobenzaprine by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Increase dose if clinically indicated .

            • onabotulinumtoxinA

              onabotulinumtoxinA and cyclobenzaprine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • opium tincture

              cyclobenzaprine and opium tincture both increase sedation. Use Caution/Monitor.

            • orphenadrine

              cyclobenzaprine and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclobenzaprine and orphenadrine both increase sedation. Use Caution/Monitor.

            • oxazepam

              oxazepam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • oxybutynin

              cyclobenzaprine and oxybutynin both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • oxybutynin topical

              cyclobenzaprine and oxybutynin topical both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • oxybutynin transdermal

              cyclobenzaprine and oxybutynin transdermal both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • oxycodone

              cyclobenzaprine and oxycodone both increase sedation. Use Caution/Monitor.

            • oxymorphone

              cyclobenzaprine and oxymorphone both increase sedation. Use Caution/Monitor.

            • paliperidone

              cyclobenzaprine and paliperidone both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              paliperidone increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • pancuronium

              cyclobenzaprine and pancuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • papaveretum

              cyclobenzaprine and papaveretum both increase sedation. Use Caution/Monitor.

            • papaverine

              cyclobenzaprine and papaverine both increase sedation. Use Caution/Monitor.

            • pentazocine

              cyclobenzaprine and pentazocine both increase sedation. Use Caution/Monitor.

            • pentobarbital

              pentobarbital and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • perphenazine

              cyclobenzaprine and perphenazine both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

              perphenazine increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • phenobarbital

              phenobarbital and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • phenylephrine PO

              cyclobenzaprine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • pholcodine

              cyclobenzaprine and pholcodine both increase sedation. Use Caution/Monitor.

            • physostigmine

              physostigmine increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pilocarpine

              pilocarpine increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pilocarpine ophthalmic

              pilocarpine ophthalmic increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pimozide

              cyclobenzaprine and pimozide both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.

              pimozide increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • prabotulinumtoxinA

              cyclobenzaprine increases effects of prabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Muscle relaxants may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

            • pralidoxime

              cyclobenzaprine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • primidone

              primidone and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • prochlorperazine

              cyclobenzaprine and prochlorperazine both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of prochlorperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor.

              prochlorperazine increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • promethazine

              promethazine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of promethazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor.

              promethazine increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • propantheline

              cyclobenzaprine and propantheline both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • propofol

              propofol and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • propylhexedrine

              cyclobenzaprine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • protriptyline

              cyclobenzaprine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclobenzaprine and protriptyline both increase sedation. Use Caution/Monitor.

            • pyridostigmine

              pyridostigmine increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • quazepam

              quazepam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • quetiapine

              cyclobenzaprine and quetiapine both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of quetiapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor.

              quetiapine increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              quetiapine, cyclobenzaprine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

            • ramelteon

              cyclobenzaprine and ramelteon both increase sedation. Use Caution/Monitor.

            • rapacuronium

              cyclobenzaprine and rapacuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • rasagiline

              rasagiline and cyclobenzaprine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • remifentanil

              cyclobenzaprine increases effects of remifentanil by pharmacodynamic synergism. Modify Therapy/Monitor Closely. CNS depressant effect increased.

            • remimazolam

              remimazolam, cyclobenzaprine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

            • rilpivirine

              rilpivirine increases toxicity of cyclobenzaprine by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.

            • risperidone

              cyclobenzaprine and risperidone both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • rocuronium

              cyclobenzaprine and rocuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • rucaparib

              rucaparib will increase the level or effect of cyclobenzaprine by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP1A2 substrates, if clinically indicated.

            • scopolamine

              cyclobenzaprine and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • scullcap

              cyclobenzaprine and scullcap both increase sedation. Use Caution/Monitor.

            • secobarbital

              secobarbital and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • selegiline

              selegiline and cyclobenzaprine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • selegiline transdermal

              selegiline transdermal and cyclobenzaprine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • shepherd's purse

              cyclobenzaprine and shepherd's purse both increase sedation. Use Caution/Monitor.

            • solifenacin

              cyclobenzaprine and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • stiripentol

              stiripentol, cyclobenzaprine. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP1A2 inhibitor and inducer. Monitor CYP1A2 substrates coadministered with stiripentol for increased or decreased effects. CYP1A2 substrates may require dosage adjustment.

              stiripentol, cyclobenzaprine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

            • succinylcholine

              succinylcholine increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sufentanil

              cyclobenzaprine and sufentanil both increase sedation. Use Caution/Monitor.

            • tapentadol

              cyclobenzaprine and tapentadol both increase sedation. Use Caution/Monitor.

              cyclobenzaprine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

            • temazepam

              temazepam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • teriflunomide

              teriflunomide decreases levels of cyclobenzaprine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

            • thioridazine

              cyclobenzaprine and thioridazine both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of thioridazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor.

              thioridazine increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • thiothixene

              cyclobenzaprine and thiothixene both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor.

              thiothixene increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • tiotropium

              cyclobenzaprine and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • tolterodine

              cyclobenzaprine and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • topiramate

              cyclobenzaprine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

            • tramadol

              cyclobenzaprine and tramadol both increase sedation. Use Caution/Monitor.

            • trazodone

              cyclobenzaprine and trazodone both increase sedation. Use Caution/Monitor.

            • triazolam

              triazolam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • triclofos

              triclofos and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              cyclobenzaprine and trifluoperazine both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor.

              trifluoperazine increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • trihexyphenidyl

              cyclobenzaprine and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.

            • trimipramine

              cyclobenzaprine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              cyclobenzaprine and trimipramine both increase sedation. Use Caution/Monitor.

            • trospium chloride

              cyclobenzaprine and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • vecuronium

              cyclobenzaprine and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

            • xylometazoline

              cyclobenzaprine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziconotide

              cyclobenzaprine and ziconotide both increase sedation. Use Caution/Monitor.

            • ziprasidone

              cyclobenzaprine and ziprasidone both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.

              ziprasidone increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • zotepine

              cyclobenzaprine and zotepine both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of zotepine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor.

            Minor (7)

            • desipramine

              cyclobenzaprine and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

            • dimenhydrinate

              dimenhydrinate increases toxicity of cyclobenzaprine by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

            • donepezil

              donepezil decreases effects of cyclobenzaprine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • eucalyptus

              cyclobenzaprine and eucalyptus both increase sedation. Minor/Significance Unknown.

            • galantamine

              galantamine decreases effects of cyclobenzaprine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • sage

              cyclobenzaprine and sage both increase sedation. Minor/Significance Unknown.

            • trazodone

              cyclobenzaprine and trazodone both decrease cholinergic effects/transmission. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            Drowsiness (up to 39% immediate-release; 100% extended-release)

            Dry mouth (21-32%)

            Dizziness (3-11%)

            1-10%

            Pharyngitis (1-3%)

            Headache (1-5%)

            Fatigue (6%)

            Palpitations (6%)

            Bad taste in mouth (1-6%)

            Indigestion (4%)

            Blurred vision (3%)

            Constipation (1-3%)

            Asthenia (1-3%)

            Confusion (1-3%)

            Nausea (1-3%)

            Nervousness (1-3%)

            <1%

            Arrhythmia

            Hypotension

            Palpitation

            Syncope

            Tachycardia

            Vasodilation

            Cardiac dysrhythmia (rare)

            Cholestasis (rare)

            Hepatitis

            Jaundice

            Anaphylaxis (rare)

            Immune hypersensitivity reaction

            Postmarketing Reports

            Serotonin syndrome

            Hypertension

            Stroke

            Heart block

            Myocardial infarction

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            Warnings

            Contraindications

            Hypersensitivity to drug or formulation components

            Hyperthyroidism

            During the acute recovery phase of myocardial infarction and in patients with arrhythmia, heart block or conduction disturbances, or congestive heart failure

            Concomitant use or within 14 days of discontinuing MAO inhibitors

            Hyperpyretic crisis seizures and deaths have occurred in patients receiving cyclobenzaprine (or structurally similar tricyclic antidepressants) concomitantly with MAO inhibitors

            Cautions

            Use only for short periods (2-3 wk)

            Use caution in urinary retention, narrow-angle glaucoma or IOP, or concomitant use of other anticholinergic drugs

            May cause drowsiness/dizziness; do not ingest alcohol or other CNS depressants; may impair ability to operate heavy machinery

            May take with food to avoid stomach upset

            Serotonin syndrome reported when coadministered with other drugs that increase serotonin (eg, SSRIs, SNRIs, TCAs, tramadol, bupropion, meperidine, verapamil, or MAO inhibitors [see also Contraindications])

            Not effective for treatment of spasticity associated with cerebral/spinal cord disease or for pediatric cerebral palsy

            Elderly patients may be more prone to adverse effects and require dose/frequency reduction

            Use immediate release with caution in hepatic impairment; extended-release form not recommended with hepatic impairment

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            Pregnancy & Lactation

            Pregnancy

            Available data from case reports with use in pregnancy have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes

            Animal data

            • In rats, decreased pup body weight and survival was noted at cyclobenzaprine doses ≥10 mg/kg/day (approximately ≥3 times maximum recommended human dose (MRHD) of 30 mg/day), when administered orally during pregnancy and lactation

            Lactation

            There are no data on presence of drug in either human or animal milk, the effects on a breastfed infant, or effects on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from therapy or from underlying maternal condition.

            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

            Relieves local skeletal muscle spasm; clinical response similar to diazepam

            Structurally related to cyclic antidepressants, and pharmacologic effects are similar, including reserpine antagonism, norepinephrine potentiation, potent peripheral and central anticholinergic effects, and sedation; reduces tonic somatic motor activity influencing alpha and gamma motor neurons

            Absorption

            Onset: 1 hr

            Duration: 12-24 hr

            Bioavailability: 33-55%

            Peak plasma time: 7-8 hr

            Peak plasma concentration: 15-25 ng/mL

            Distribution

            Protein bound: 93%

            Metabolism

            Hepatic via CYP3A4, 1A2, and 2D6; may undergo enterohepatic recirculation

            Elimination

            Half-life: 8-37 hours (immediate release); 32-33 hr (extended release)

            Excretion: Urine, feces

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            cyclobenzaprine oral
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            10 mg tablet
            cyclobenzaprine oral
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            7.5 mg tablet
            cyclobenzaprine oral
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            5 mg tablet
            cyclobenzaprine oral
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            10 mg tablet
            cyclobenzaprine oral
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            5 mg tablet
            cyclobenzaprine oral
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            10 mg tablet
            cyclobenzaprine oral
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            10 mg tablet
            cyclobenzaprine oral
            -
            10 mg tablet
            cyclobenzaprine oral
            -
            7.5 mg tablet
            cyclobenzaprine oral
            -
            10 mg tablet
            cyclobenzaprine oral
            -
            5 mg tablet
            cyclobenzaprine oral
            -
            10 mg tablet
            cyclobenzaprine oral
            -
            30 mg capsule
            cyclobenzaprine oral
            -
            5 mg tablet
            cyclobenzaprine oral
            -
            15 mg capsule
            cyclobenzaprine oral
            -
            7.5 mg tablet
            cyclobenzaprine oral
            -
            10 mg tablet
            cyclobenzaprine oral
            -
            5 mg tablet
            cyclobenzaprine oral
            -
            15 mg capsule
            cyclobenzaprine oral
            -
            7.5 mg tablet
            cyclobenzaprine oral
            -
            15 mg capsule
            cyclobenzaprine oral
            -
            5 mg tablet
            cyclobenzaprine oral
            -
            30 mg capsule
            cyclobenzaprine oral
            -
            15 mg capsule
            cyclobenzaprine oral
            -
            30 mg capsule
            cyclobenzaprine oral
            -
            10 mg tablet
            cyclobenzaprine oral
            -
            5 mg tablet
            cyclobenzaprine oral
            -
            7.5 mg tablet
            cyclobenzaprine oral
            -
            7.5 mg tablet
            cyclobenzaprine oral
            -
            10 mg tablet
            cyclobenzaprine oral
            -
            30 mg capsule
            cyclobenzaprine oral
            -
            5 mg tablet
            Fexmid oral
            -
            7.5 mg tablet
            Amrix oral
            -
            15 mg capsule
            Amrix oral
            -
            30 mg capsule

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            cyclobenzaprine oral

            CYCLOBENZAPRINE - ORAL

            (sye-klo-BENZ-uh-preen)

            COMMON BRAND NAME(S): Flexeril

            USES: Cyclobenzaprine is used short-term to treat muscle spasms. It is usually used along with rest and physical therapy. It works by helping to relax the muscles.

            HOW TO USE: Take this medication by mouth with or without food as directed by your doctor. Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.The dosage is based on your medical condition and response to treatment. This medication should only be used short-term (for 3 weeks or less) unless directed by your doctor.Tell your doctor if your condition persists after 2 to 3 weeks or if it worsens.

            SIDE EFFECTS: Drowsiness, dizziness, dry mouth, constipation, or tiredness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: fast/irregular heartbeat, mental/mood changes (such as confusion, hallucinations), trouble urinating.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking cyclobenzaprine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, overactive thyroid (hyperthyroidism), heart problems (such as irregular heartbeat, heart block, heart failure, recent heart attack), difficulty urinating (such as due to an enlarged prostate), glaucoma.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially drowsiness, confusion, constipation, or trouble urinating. Drowsiness and confusion can increase the risk of falling.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. However, similar drugs pass into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: tricyclic antidepressants (such as amitriptyline, imipramine).Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.Before using this medication, report the use of drugs that increase serotonin, including street drugs (such as MDMA/"ecstasy"), St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), tramadol, among others.Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), other muscle relaxants (such as carisoprodol, methocarbamol), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: fast/irregular heartbeat, fainting, severe drowsiness, trouble speaking, seizures, mental/mood changes (such as confusion, hallucinations).

            NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another condition unless your doctor directs you to do so. A different medication may be necessary in that case.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.