Zanaflex warning

[Pharmacist.steve]

FDA - MedWatch - Zanaflex (tizanidine hydrochloride) Tablets and Capsules - Changes to the CONTRAINDICATIONS and WARNINGS Sections of the Approved Product Labeling
MedWatch - The FDA Safety Information and Adverse Event Reporting Program

Acorda Therapeutics and FDA informed healthcare professionals of changes to the CONTRAINDICATIONS and WARNINGS Sections of the product labeling for Zanaflex, a drug used to treat spasticity, In pharmacokinetic studies where tizanidine was coadministered with either fluvoxamine or ciprofloxacin (CYP1A2 inhibitors), the serum concentration of tizanidine was significantly increased and potentiated its hypotensive and sedative effects. Although there are no clinical studies evaluating the effects of other CYP1A2 inhibitors on tizanidine, coadministration of tizanidine with other CYP1A2 inhibitors (zileuton, other fluroquinolones, antiarrythmics, cimetidine, famotidine, oral contraceptives, acyclovir and ticlopidine) should be avoided.

Read the complete MedWatch 2007 Safety summary, including a link to the manufacturer's Dear Healthcare Provider Letter regarding this issue at:

http://www.fda.gov/medwatch/safety/2...7.htm#Zanaflex

[Mark N]

Steve thanks for keeping us up to date with these warnings.

[Smiling Angel]

Steve - you are the perfect person to ask this question. It's about muscle relaxors. My daughter is Dxed bipolar and takes sveral meds - Abilify, Lamictal, Lithium, Zoloft, and Klonipin. She also has chroniic pain and muscle sppasms iin her miiddle and lower back, has been seeing my PM doc for years now, and gets Vicodin ES and Soma from him. She doesn't really want to take the Soma anymore - because, being an addictive personality, she tends to abuse it, taking too many pills at a time (I normally keep them iin my safe). She is finally realizing that she needs to switch to another muscle relaxor. She's tried Zanaflex, and it makes her too tired, and she ends up sleeping too much during the day. I take Skelaxin, but that doesn't seem to help her very much, either. What other choices are out there? - flexeril is the only one I can think of, not sure if she's tried that or not.

Any ideas? I can normally be found on the Spinal Disorders forum, but I fit iin here as well (I take Kadian 30mg bid, w/ Vicodin ES for BT pain)

Jacquie
Any help would be greatly appreciated!

[Pharmacist.steve]

Originally Posted by Smiling Angel

Steve - you are the perfect person to ask this question. It's about muscle relaxors. My daughter is Dxed bipolar and takes sveral meds - Abilify, Lamictal, Lithium, Zoloft, and Klonipin. She also has chroniic pain and muscle sppasms iin her miiddle and lower back, has been seeing my PM doc for years now, and gets Vicodin ES and Soma from him. She doesn't really want to take the Soma anymore - because, being an addictive personality, she tends to abuse it, taking too many pills at a time (I normally keep them iin my safe). She is finally realizing that she needs to switch to another muscle relaxor. She's tried Zanaflex, and it makes her too tired, and she ends up sleeping too much during the day. I take Skelaxin, but that doesn't seem to help her very much, either. What other choices are out there? - flexeril is the only one I can think of, not sure if she's tried that or not.

Any ideas? I can normally be found on the Spinal Disorders forum, but I fit iin here as well (I take Kadian 30mg bid, w/ Vicodin ES for BT pain)

Jacquie
Any help would be greatly appreciated!

There is also Robaxin and some use Baclofen.. most/all of the muscle relaxants are going to cause some degree of drowiness. Given her circumstances, I would see if a T.E.N.S. unit may be of benefit. T.E.N.S. units have sort of faded because people try to use them for extended periods of time and the body will accommodate the electrical stimuli. But trying to use one to fatigue or over-stimulate the muscle group that is the problem. This would be in conjunction with some low doses of muscle relaxants.. used much the same way that chronic painers use break thru meds. Using these intermittently will dramatically slow down or eliminate the accommodation of the elec stimuli.

Using it in this manner should deplete the acetylcholine in the nerve synapse which is the methodology the body uses to cause muscle contractions. However, if the muscle is going into spasms because of problems within the internal structure of the muscle itself.. it MAY not help.

You should be able to rent a T.E.N.S. for a month - with a doc's order. That should be more than enough time to evaluate how effective it would be.

[painiac]

Bravo............good word. They don't work for everyone but are a true blessing for those who they do work for. I keep mine at the top of my bag of tricks and am now working on my third one in 15 years.

[Kathi49]

Me too! I love mine! I usually use it for an hour or two and it IS a blessing especially during those times when you just can't stomach another med. And, yes, I know...they don't work for everyone. And Steve is right, there have been times I kept it on longer than I should have and my muscles didn't really like that too much. But again, for those bad times...it certainly has helped me to take the edge off.

[lobelsteve]

Flexeril= CYCLOBENZAPRINE
Parafon Forte= chlorzoxazone
Norflex= orphenadrine
Baclofen= lioresal
Skelaxin= metaxalone
Soma= carisoprodol
Zanaflex= tizanidine

Dantrium= dantrolene - but it is only used for spasticity and rarely at that.

[BrokenBladder]

Steve thanks so much for keeping us informed!!
I'm one of those people that hasn't had any luck with the tens unit. I've tried it so many times and for some reason my muscles hate it. I take Soma instead.

[Lea]

Originally Posted by lobelsteve

Flexeril= CYCLOBENZAPRINE
Parafon Forte= chlorzoxazone
Norflex= orphenadrine
Baclofen= lioresal
Skelaxin= metaxalone
Soma= carisoprodol
Zanaflex= tizanidine

Dantrium= dantrolene - but it is only used for spasticity and rarely at that.

I thought that Soma has fallen out of favor with most PM's due to its propensity to be abused.

[lobelsteve]

I avoid its use for two important reasons.

1. Metabolite is active and is called meprobamate. THis was an antipsychotic used 20 years ago under the brand name Milltown.

2. It is a drug of abuse as much as an opioid and it has a street value.

3. Other reasons are because it can have its own withdrawal syndrome and that it is more sedating than most other muscle relaxants.