MUSCLE SPASMS †

Generic name Brand & Class Strength Formulations‡ Usual Adult Dose
␣2-ADRENERGIC AGONIST
Tizanidine HCl ZANAFLEX TABLETS 4mg 嗱 scored tabs Initially: usually 4mg, may increase by 2–4mg as needed every 6–8 hrs
(Acorda Therapeutics) to a max of 3 doses in 24hrs; max 12mg/dose and 36mg/day.
Renal impairment (CrCl ⬍25mL/min): reduce dose.
ZANAFLEX CAPSULES 2mg, 4mg, 6mg 嗱 caps May sprinkle contents of capsules on applesauce (may affect
(Acorda Therapeutics) absorption). Tabs and caps not bioequivalent under fed conditions.
ANTICHOLINERGIC MUSCLE RELAXANT (CENTRAL)
Orphenadrine citrate NORFLEX 100mg 嗱 sust-rel tabs 100mg twice daily (AM and PM).
(Graceway)
NORFLEX INJECTION 60mg/2mL 嗱 inj* 60mg IM or IV every 12 hrs.
(Graceway)
ANTICHOLINERGIC MUSCLE RELAXANT (CENTRAL) + SALICYLATE
Orphenadrine citrate (various) 25mg 嗱 tabs 1–2 tabs 3–4 times daily.
Aspirin 385mg
Caffeine 30mg
Orphenadrine citrate (various) 50mg 嗱 scored tabs ½–1 tab 3–4 times daily; max 4 tabs daily.
Aspirin 770mg
Caffeine 60mg
BENZODIAZEPINE
Diazepam DIAZEPAM ORAL 5mg/5mL CIV soln 2–10mg 3–4 times daily.
SOLUTION Elderly, debilitated: initially 2–2.5mg 1–2 times daily; increase gradually.
(Roxane)
Diazepam injection 5mg/mL CIV inj⌬ Initially 5–10mg slow IV (5mg/min) or IM. May repeat after 3–4 hours.
(various) Tetanus: may need larger dose. Do not use small vein.
DIAZEPAM INTENSOL 5mg/mL CIV concentrated 2–10mg 3–4 times daily.
(Roxane) soln** Elderly, debilitated: initially 2–2.5mg 1–2 times daily; increase gradually.
Intensol: mix with liquid or semi-solid food.
VALIUM 2mg, 5mg, 10mg CIV scored tabs 2–10mg 3–4 times daily.
(Roche) Elderly, debilitated: initially 2–2.5mg 1–2 times daily; increase gradually.
CHOLINESTERASE INHIBITOR
Pyridostigmine MESTINON 60mg 嗱 scored tabs Usually 600mg daily in divided doses.
bromide (Valeant)
MESTINON SYRUP 60mg/5mL 嗱 syrup⌺
(Valeant)
MESTINON TIMESPAN 180mg 嗱 sust-rel scored Usually 1–3 tabs 1–2 times daily.
(Valeant) tabs
MUSCLE RELAXANT (CENTRAL)
Cyclobenzaprine HCl AMRIX 15mg, 30mg 嗱 ext-rel caps Take at same time each day. 15mg once daily; may increase to
(Cephalon) 30mg/day given once daily. Max 2–3 weeks.
Baclofen (various) 10mg, 20mg 嗱 scored tabs 5mg 3 times daily. Increase in increments of 5mg 3 times daily every
3 days if needed; max 80mg daily.
Cyclobenzaprine HCl FEXMID 7.5mg 嗱 tabs ⱖ15yrs: initially 5mg 3 times daily; may increase to 7.5mg or 10mg
(Victory Pharma) 3 times daily. Max 2–3 weeks.
⬍15yrs: not recommended.
FLEXERIL 5mg, 10mg 嗱 tabs ⱖ15yrs: initially 5mg 3 times daily; may increase to 10mg 3 times
(McNeil Consumer & daily. Max 2–3 weeks.
Specialty) ⬍15yrs: not recommended.
Chlorzoxazone PARAFON FORTE DSC 500mg 嗱 scored caplets 500mg 4 times daily; max 750mg 4 times daily.
(Ortho-McNeil)
Methocarbamol ROBAXIN 500mg 嗱 tabs ⱖ16yrs: initially 1.5g 4 times daily for 2–3 days.
(UCB) Maintenance: 4g daily in divided doses.
ROBAXIN-750 750mg 嗱 tabs ⬍16yrs: not recommended.
(UCB)
Metaxalone SKELAXIN 800mg 嗱 scored tabs 800mg 3-4 times daily.
(King) ⱕ12yrs: not recommended.
Carisoprodol SOMA 350mg 嗱 tabs ⱖ16yrs: 250mg–350mg 3 times daily and at bedtime.
(Meda) Max 2–3 weeks.
SOMA 250 250mg 嗱 tabs ⬍16yrs: not recommended.
(Meda)
MUSCLE RELAXANT (LOCAL)
Dantrolene sodium DANTRIUM 25mg, 50mg, 嗱 caps 25mg once daily for 7 days, then 25mg 3 times daily for 7 days, then
(Proctor & Gamble) 100mg 50mg 3 times daily for 7 days, then 100mg 3 times daily; max 100mg
4 times daily.
MUSCLE RELAXANT (CENTRAL) + SALICYLATE
Carisoprodol (various) 200mg 嗱 tabs 1–2 tabs 4 times daily.
Aspirin 325mg
MUSCLE RELAXANT (CENTRAL) + SALICYLATE + OPIOID
Carisoprodol (various) 200mg CIII tabs* 1–2 tabs 4 times daily.
Aspirin 325mg
Codeine phosphate 16mg
NOTES
‡caps = capsules; tabs = tablets; ext-rel = extended-release; inj = injection; soln = solution; sust-rel = sustained-release; amp = ampule
*Contains sulfites. **Contains alcohol 19%. ⌬Contains propylene glycol 40%, ethyl and benzyl alcohol. ⌺Contains alcohol 5%.
†Not an inclusive list. Please see drug monographs or visit www.empr.com. (Created 3/2009)