From the Guidelines
Weaker muscle relaxers, such as tizanidine (Zanaflex) at 2-4mg, are recommended for spasticity resulting in pain, poor skin hygiene, or decreased function, as they have a more favorable safety profile compared to stronger alternatives like carisoprodol (Soma) or higher doses of the same medications 1. Some other weaker muscle relaxers include:
- Cyclobenzaprine (Flexeril) at 5-10mg doses
- Methocarbamol (Robaxin) at 500-750mg
- Baclofen at lower doses (5-10mg) These medications are considered milder options and work by affecting different pathways in the central nervous system to reduce muscle tone and spasm without causing excessive sedation. They're typically prescribed for short-term use (1-3 weeks) for acute muscle spasms or pain. Side effects are generally milder but can still include drowsiness, dizziness, and dry mouth. It's essential to start with the lowest effective dose, avoid alcohol while taking these medications, and not drive until you know how the medication affects you. These medications should be taken as prescribed and discontinued gradually rather than stopped abruptly. It's also important to note that diazepam or other benzodiazepines are not recommended during the stroke recovery period due to possible deleterious effects on recovery and sedation side effects 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Weaker Muscle Relaxers
Some weaker muscle relaxers include:
- Cyclobenzaprine at a lower dose (2.5 mg or 5 mg) TID, as it has been shown to be effective in improving muscle spasm and reducing pain with less sedation compared to the usual dosage of 10 mg TID 2
- Metaxalone, which has been found to have a lower risk of opioid overdose compared to other muscle relaxants such as baclofen and carisoprodol 3
- Chlorzoxazone and orphenadrine, which have been shown to be effective in treating musculoskeletal conditions, but with limited data on their relative efficacy and safety compared to other muscle relaxants 4, 5
Comparison of Muscle Relaxants
A comparative review of muscle relaxants found that:
- Cyclobenzaprine, carisoprodol, and metaxalone are effective in treating musculoskeletal conditions, but with varying degrees of evidence and potential for adverse effects 4, 5
- Baclofen and tizanidine are effective in treating spasticity, but with a higher risk of adverse effects such as dry mouth and weakness 4
- The concomitant use of prescription opioids and skeletal muscle relaxants increases the risk of opioid overdose, with baclofen being associated with a higher risk compared to cyclobenzaprine 3
Adverse Effects
Common adverse effects of muscle relaxants include:
- Sedation and drowsiness, which can be dose-related and may be less severe with lower doses of cyclobenzaprine 2
- Dry mouth, which is more commonly associated with tizanidine 4
- Dizziness and fatigue, which can be central nervous system-related and may be more common with certain muscle relaxants such as carisoprodol and metaxalone 5