Muscle relaxants include carisoprodol, cyclobenzaprine, and orphenadrine and may be prescribed by a doctor for the treatment of muscle pain caused by muscle contractures, torticollis, fibromyalgia, low back pain, and acute crises of rheumatoid arthritis.
These medications work by blocking nerve impulses and pain sensations sent from the brain that cause contractions, spasms, and muscle pain. This helps relax the muscles in order to facilitate movement and reduce acute pain.
Muscle relaxants may sometimes contain other substances in their composition to enhance their effects. Muscle relaxants should be taken only as directed by a doctor for the established length of treatment.
Examples of common muscle relaxants include:
1. Carisoprodol
Carisoprodol is a muscle relaxant prescribed for muscle pain in adults and adolescents over the age of 14 caused by rheumatism, acute attacks of gout or rheumatoid arthritis, low back pain, and post-op pain.
Carisoprodol is prescribed as a single medication under the brand name Soma and in combination with aspirin and codeine (Soma Compound with Codeine).
Dosing instructions: The recommended dose of carisoprodol is 250 mg to 350 mg three times a day and at bedtime for no more then two to three weeks. The recommended daily dose of Soma Compound with Codeine for adults is 1 or 2 tablets taken four times a day for a maximum of two to three weeks.
Contraindications: People who are pregnant or breastfeeding and those who have high blood pressure, heart failure, or severe liver or kidney disease should only take carisoprodol if advised to by a doctor. People with an allergy or hypersensitivity to aspirin or any other NSAID should not take carisoprodol with aspirin and codeine.
2. Cyclobenzaprine
Cyclobenzaprine is prescribed for the treatment of muscle pain caused by torticollis, fibromyalgia, frozen shoulder, low back pain, and neck pain that radiates to the arm.
This medication comes in the form a pill that can be found at pharmacies and drugstores under the brand name Flexeril, among others.
Dosing instructions: The typically recommended dose of cyclobenzaprine is 5 mg three times a day, which may be increased to 10 mg three times a day by the prescribing provider as needed.
Contraindications: Cyclobenzaprine should not be prescribed for children under 15 years of age. People who are pregnant or breastfeeding should only take cyclobenzaprine if approved by their OBGYN or midwife.
Cyclobenzaprine is contraindicated in people with hyperthyroidism and heart problems like myocardial infarction (heart attack), congestive heart failure, arrhythmias, and heart block and should be used with caution in people with glaucoma and urinary retention.
3. Orphenadrine
Orphenadrine is a muscle relaxant prescribed for muscle contractures, sprains and strains, tension headaches, dislocations, a pulled muscle, or torticollis.
Orphenadrine is sold as a standalone medication under the brand name Norflex and is also available in combination with aspirin and caffeine under the brand name Orphengesic Forte. The combination of aspirin and caffeine enhances the anti-inflammatory and relaxing effects of orphenadrine.
Dosing instructions: The typical dose of orphenadrine is 100 mg twice a day (taken by mouth) or a 60 mg injection given every 12 hours. The recommended dose of Orphengesic Forte is 0.5 to 1 tablet three to four times per day.
Contraindications: Orphenadrine should not be given to children or people who are pregnant or breastfeeding unless approved by a doctor.
Orphenadrine is contraindicated in people with glaucoma, stomach or intestinal obstruction, stomach ulcers, megaesophagus, enlarged prostate, myasthenia gravis, obstruction of the bladder neck, and heart problems. It should not be taken by people with an allergy to orphenadrine.
4. Baclofen
Baclofen is a muscle relaxant indicated for relief of muscle pain and stiffness caused by multiple sclerosis, inflammation or injury to the spinal cord (such as myelitis), or post-stroke conditions.
Baclofen helps relax the muscles, relieve pain, and improve mobility to perform activities of daily living and physical therapy exercises. It should be taken only as prescribed by a doctor.
Dosing instructions: The typical starting dose of baclofen for adults is 5 mg three times day. This can be increased by a doctor every three days to a maximum of 80 mg per day.
Contraindications: Baclofen is contraindicated in people with an allergy to baclofen or any components of its formula. Baclofen should be used with caution (and always under the supervision of a doctor) in people who are pregnant or breastfeeding and in people with Parkinson's disease, epilepsy, stomach ulcers, kidney problems, liver disease, or diabetes.
5. Tizanidine
Tizanidine is a muscle relaxant indicated for the relief of muscle spasms caused by disorders of the cervical or lumbar spine due to hip arthritis or following surgery for a herniated disc, or neurological disorders like multiple sclerosis, stroke, or cerebral palsy.
This medication is sold as the generic "tizanidine" and under the brand name Zanaflex, among others. It is a prescription-only medication indicated for adults and must be taken under the supervision of a doctor or other healthcare provider.
Dosing instructions: Doses of tizanidine vary based on the condition being treated. The starting dose is typically 2 mg three times a day and can be increased gradually to a maximum of 36 mg per day divided into three doses.
Contraindications: Tizanidine is contraindicated in people taking fluvoxamine or ciprofloxacin and should be avoided during pregnancy and lactation and in people with severe kidney disease.
6. Diazepam
Diazepam is a muscle relaxant indicated for the relief of muscle spasms and severe muscle pain in cases of localized trauma such as injuries or inflammation or for the treatment of muscle spasticity that may occur in cases of cerebral palsy, paraplegia (paralysis of the legs), and other nervous system disorders. Diazepam is part of a class of medications called benzodiazepines.
In addition to relaxing the muscles, diazepam is also used to treat anxiety and agitation and may be prescribed by a doctor to help with sleep. Better sleep also requires practicing good sleep hygiene and planning for a good night's rest.
Diazepam is a prescription-only medication sold as the generic "diazepam" as well as under the brand name Valium.
Dosing instructions: The recommended dose for adults is 2 to 10 mg two to four times per day, depending on the condition being treated and the severity of symptoms.
Contraindications: Diazepam is contraindicated in people with severe respiratory or liver insufficiency, obstructive sleep apnea, or myasthenia gravis and should not be used during pregnancy or lactation or by people with substance use disorders (including alcohol).
Indications for use
Muscle relaxants are typically indicated for conditions that present with moderate to severe muscle tension and/or painful contractures (like torticollis or lumbar pain).
In general, muscle relaxants should only be used as a last resort, for the shortest time possible, and always under the supervision of a doctor or advanced practice provider.
The use of muscle relaxants should be combined with regular physical exercise to help prevent the development of contractures and daily stretching to help stretch and elongate the muscles. This is especially important for those who work sitting at a desk all day.
Natural remedies
Natural remedies can also be used to promote muscle relaxation and relieve muscle tension and pain, helping treat contractures, torticollis, back pain, and sprains.
One example is applying a relaxing compress made with 1 drop each of rosemary and lavender essential oils.
To make this compress, first wet a towel with warm water, add the drops of essential oils, and apply the compress to the affected area.
Other tips for treating muscle contractures include taking a warm bath, applying a hot pack, or massaging the area with relaxing essential oils like bitter orange, which can help relieve pain and relax the muscles.
It is important to emphasize that natural remedies are not a substitute for treatments prescribed by a doctor and should only be used to complement treatment with medications and/or physical therapy.