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A List of Skeletal muscle relaxants

muscle relaxant is a drug that affects skeletal muscle function and decreases the muscle tone.

muscle relaxant
muscle relaxant

It may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia. The term “muscle relaxant” is used to refer to two major therapeutic groups: neuromuscular blockers and spasmolytics. Neuromuscular blockers act by interfering with transmission at the neuromuscular end plate and have no central nervous system (CNS) activity.

They are often used during surgical procedures and in intensive care and emergency medicine to cause temporary paralysis. Spasmolytics, also known as “centrally acting” muscle relaxants, are used to alleviate musculoskeletal pain and spasms and to reduce spasticity in a variety of neurological conditions. While both neuromuscular blockers and spasmolytics are often grouped together as muscle relaxants, the term is commonly used to refer to spasmolytics only.

How Skeletal Muscle Contracts

A single α-motor neuron can innervate up to 200 muscle fibers, forming a complex called motor unit (Figure 1).10 With movement, an action potential originates from the UMN in the motor cortex.9 This action potential depolarizes the motor neuron terminal, resulting in the opening of voltage-gated calcium (Ca2+) channels and the subsequent release of the neurotransmitter acetylcholine (Ach) into the synaptic cleft. In the synaptic cleft, Ach binds to nicotinic cholinergic receptors on the muscle fiber membrane, leading to an influx of sodium (Na+) and a discharge of potassium (K) across the muscle fiber’s membrane, which results in depolarization of the muscle fiber.11 This depolarization opens voltage-gated Ca2+ channels on the sarcoplasmic reticulum (via ryanodine and inositol triphosphate receptors), allowing for Ca2+ influx into the cytoplasm of striated muscle cells.12  The Ca2+ then binds to troponin C, which exposes myosin-binding sites on actin filaments. A cross-link forms between actin and myosin, leading to muscle contraction. The pumping of Ca2+ back into the sarcoplasmic reticulum, using adenosine triphosphate, leads to cessation of contraction.

 

View by: Brand

Drug Name Reviews Avg. Ratings
Antiflex
Generic name: orphenadrine
1 review
  
10
Dantrium (Pro)
Generic name: dantrolene
2 reviews
  
10
Vanadom
Generic name: carisoprodol
1 review
  
9.0
Soma (Pro)
Generic name: carisoprodol
180 reviews
  
8.9
Zanaflex (Pro)
Generic name: tizanidine
100 reviews
  
7.7
Xeomin (Pro)
Generic name: incobotulinumtoxinA
2 reviews
  
7.5
Amrix (Pro)
Generic name: cyclobenzaprine
48 reviews
  
7.3
Myobloc (Pro)
Generic name: rimabotulinumtoxinB
3 reviews
  
7.2
Skelaxin (Pro)
Generic name: metaxalone
82 reviews
  
7.2
Lioresal (Pro)
Generic name: baclofen
20 reviews
  
6.8
Norflex (Pro)
Generic name: orphenadrine
22 reviews
  
6.5
Flexeril (Pro)
Generic name: cyclobenzaprine
197 reviews
  
6.3
Robaxin (Pro)
Generic name: methocarbamol
63 reviews
  
6.3
Lorzone (Pro)
Generic name: chlorzoxazone
21 reviews
  
6.2
Dysport (Pro)
Generic name: abobotulinumtoxinA
7 reviews
  
6.1
Botox (Pro)
Generic name: onabotulinumtoxinA
350 reviews
  
5.9
Parafon Forte DSC (Pro)
Generic name: chlorzoxazone
3 reviews
  
5.9
Fexmid (Pro)
Generic name: cyclobenzaprine
4 reviews
  
5.8
Gablofen (Pro)
Generic name: baclofen
3 reviews
  
5.8
Robaxin-750
Generic name: methocarbamol
39 reviews
  
5.6
Lioresal Intrathecal
Generic name: baclofen
3 reviews
  
5.2
Botox Cosmetic (Pro)
Generic name: onabotulinumtoxinA
11 reviews
  
4.9
Comfort Pac with Cyclobenzaprine
Generic name: cyclobenzaprine
2 reviews
  
4.5
Orfro
Generic name: orphenadrine
0 reviews
  
3.0
Kemstro
Generic name: baclofen
0 reviews
  
2.0
Dantrium Intravenous (Pro)
Generic name: dantrolene
0 reviews Add rating
Mio-Rel
Generic name: orphenadrine
0 reviews Add rating
Orphenate
Generic name: orphenadrine
0 reviews Add rating
Ozobax (Pro)
Generic name: baclofen
0 reviews Add rating
Paraflex
Generic name: chlorzoxazone
0 reviews Add rating
Remular-S
Generic name: chlorzoxazone
0 reviews Add rating
Revonto (Pro)
Generic name: dantrolene
0 reviews Add rating
Ryanodex (Pro)
Generic name: dantrolene
0 reviews Add rating

Further information

Muscle Spasms

A muscle spasm is a sudden involuntary contraction of a muscle group that involves jerking and twitching. Unlike spasticity, which is a disorder of the CNS, muscle spasms arise from a variety of peripheral musculoskeletal conditions, such as mechanical low back pain. Common skeletal muscle conditions that cause spasms include fibromyalgia, myofascial pain syndrome, and mechanical low back or neck pain.

Antispasm Agents

Most of the agents discussed here are FDA approved for adjunctive use to treat muscle spasms and pain associated with acute musculoskeletal conditions (Table 4). Health data from 2003 to 2004 revealed that cyclobenzaprine (Amrix, Fexmid, others), carisoprodol (Soma, others), and metaxalone (Metaxall, Skelaxin, others) accounted for more than 45% of medications prescribed for acute musculoskeletal pain.

Due to CNS depression, cyclobenzaprine, metaxalone, orphenadrine (Norflex, others), methocarbamol (Robaxin, others), carisoprodol, and chlorzoxazone (Lorzone, Parafon Forte DSC, others) are on the American Geriatrics Society’s Beers List of inappropriate drugs for elderly patients.

Despite this, approximately 300,000 annual prescriptions for skeletal muscle relaxants (15%) are issued to patients older than 65 years of age.

Skeletal muscle relaxants represent a diverse pharmacotherapeutic group of medications across several chemical classes that are structurally dissimilar. These agents are effective for spasticity, skeletal muscle spasms, or both.

Because of the breadth of pharmacologic mechanisms and variable pharmacokinetics, the drugs have a huge range of AEs and potential drug interactions.

Considering that these agents are most often used in the elderly and also as adjuvants for the treatment of chronic pain patients with multiple comorbidities who are likely receiving a polypharmaceutical regimen (including opioids), skeletal muscle drug selection for each patient requires careful attention to these factors.

Warnings for prescription muscle relaxants

Muscle relaxants such as carisoprodol and diazepam can be habit forming. Be sure to take your medication exactly as prescribed by your doctor.

Muscle relaxants can also cause withdrawal symptoms, such as seizures or hallucinations (sensing things that aren’t real). Do not suddenly stop taking your medication, especially if you’ve been taking it for a long time.

Also, muscle relaxants depress your central nervous system (CNS), making it hard to pay attention or stay awake. While taking a muscle relaxant, avoid activities that require mental alertness or coordination, such as driving or using heavy machinery.

You should not take muscle relaxants with:

  • alcohol
  • CNS depressant drugs, such as opioids or psychotropics
  • sleeping medications
  • herbal supplements such as St. John’s wort

Talk to your doctor about how you can safely use muscle relaxants if you:

  • are older than 65 years
  • have a mental health problem or brain disorder
  • have liver problems

Off-label medications for spasticity

Doctors can use certain medications to treat spasticity even when the drugs are not approved for that purpose by the U.S. Food and Drug Association (FDA). This is called off-label drug use. The following drugs are not actually muscle relaxants, but they can still help relieve symptoms of spasticity.

Benzodiazepines

Benzodiazepines are sedatives that can help relax muscles. They work by increasing the effects of certain neurotransmitters, which are chemicals that relay messages between your brain cells.

Examples of benzodiazepines include:

  • clonazepam (Klonopin)
  • lorazepam (Ativan)
  • alprazolam (Xanax)

Side effects of benzodiazepines can include drowsiness and problems with balance and memory. These drugs can also be habit forming.

Clonidine

Clonidine (Kapvay) is thought to work by preventing your nerves from sending pain signals to your brain or by causing a sedative effect.

Clonidine should not be used with other muscle relaxants. Taking it with similar drugs increases your risk of side effects. For instance, taking clonidine with tizanidine can cause very low blood pressure.

Clonidine is available in brand-name and generic versions.

Gabapentin

Gabapentin (Neurontin) is an anticonvulsant drug typically used to relieve seizures. It’s not fully known how gabapentin works to relieve muscle spasticity. Gabapentin is available in brand-name and generic versions.

Over-the-counter options for muscle spasms

OTC treatment is recommended as first-line therapy for muscle spasms caused by conditions such as acute lower back pain or tension headache. This means you should try OTC treatments before prescription medications.

OTC treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or a combination of both. Your doctor or pharmacist can help you choose an OTC treatment.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs work by blocking your body from making certain substances that cause inflammation and pain. NSAIDs are available in generic and brand-name versions. They’re typically sold over the counter. Stronger versions are available by prescription.

NSAIDs come as oral tablets, capsules, or suspensions. They also come as chewable tablets for children. Side effects of these drugs can include upset stomach and dizziness.

Examples of NSAIDs include:

  • ibuprofen (Advil, Motrin)
  • naproxen (Aleve)

Acetaminophen

Acetaminophen (Tylenol) is thought to work by blocking your body from making certain substances that cause pain. Acetaminophen is available in generic and brand-name versions. It comes as immediate-release and extended release oral tablets and capsules, orally disintegrating tablets, chewable tablets, and oral solutions.

The more common side effects of acetaminophen can include nausea and upset stomach.

Posted in Muscle Relaxant

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