From the Guidelines
Baclofen and tizanidine are muscle relaxers that may cause less drowsiness compared to other options, with baclofen typically starting at 5-10mg three times daily and tizanidine usually beginning at 2-4mg every 6-8 hours as needed. According to the evidence from 1, skeletal muscle relaxants were associated with a higher total number of adverse events and central nervous system adverse events compared with placebo, although most events were self-limited and serious complications were rare.
Key Considerations
- Cyclobenzaprine and methocarbamol tend to cause more sedation and should be avoided if drowsiness is a concern, as noted in 2 and 3.
- Non-medication approaches like physical therapy, gentle stretching, heat therapy, and massage can also help relieve muscle tension without sedative effects.
- It's essential to consult with a healthcare provider before starting any medication, as they can recommend the most appropriate option based on specific conditions, medical history, and other medications being taken.
- Starting with the lowest effective dose and taking the medication at bedtime can help minimize daytime drowsiness if it occurs, as suggested by the general principles of medication management.
Additional Evidence
The evidence from 4 and 5 supports the use of tizanidine for acute low back pain, with 8 trials showing its efficacy. However, there is only sparse evidence on the efficacy of antispasticity drugs like dantrolene and baclofen for low back pain.
Recommendation
Given the potential for drowsiness with muscle relaxants, it is crucial to weigh the benefits and risks of each medication and consider non-medication approaches. The choice of muscle relaxant should be individualized, taking into account the patient's specific condition, medical history, and other medications they may be taking, as well as the potential for adverse events, as discussed in 6.
From the Research
Muscle Relaxers without Drowsiness
- The studies 7, 8, 9, 10, 11 provide information on various muscle relaxers, but none directly address the issue of drowsiness as a side effect.
- However, some muscle relaxers mentioned in the studies are known to have fewer side effects, including drowsiness, compared to others.
- Tizanidine is mentioned in several studies 8, 9, 11 as a muscle relaxer with a slightly different side-effects profile compared to other drugs like baclofen.
- Metaxalone is reported to have the fewest reports of side effects, including no reports of major safety issues, in a study 10.
- Cyclobenzaprine is noted to cause lethargy and anticholinergic side effects, which may include drowsiness, in the same study 10.
- Dantrolene is mentioned in studies 7, 8, 9 as a muscle relaxer, but its side effects are not specifically discussed in relation to drowsiness.
- It is essential to consult the studies and medical professionals to determine the best muscle relaxer for individual needs, considering factors like efficacy, safety, and potential side effects, including drowsiness.