From the Guidelines
Cyclobenzaprine (Flexeril) is generally considered the least sedating muscle relaxer among commonly prescribed options. It's typically prescribed at 5-10 mg doses taken up to three times daily for acute muscle spasms, with treatment usually lasting 2-3 weeks. While cyclobenzaprine still causes some sedation, it tends to produce less drowsiness than alternatives like carisoprodol (Soma) or metaxalone (Skelaxin) 1. The reduced sedation is related to its chemical structure, which is similar to tricyclic antidepressants, giving it muscle-relaxing properties with more moderate central nervous system depression. Despite being less sedating, patients should still exercise caution when driving or operating machinery, especially when first starting treatment. Other options with relatively lower sedation profiles include methocarbamol (Robaxin) and tizanidine (Zanaflex), though individual responses vary significantly 1. Taking the medication at bedtime can help minimize daytime drowsiness while still providing muscle relaxation benefits.
Some key points to consider when prescribing muscle relaxers include:
- The potential for central nervous system adverse effects, such as sedation and dizziness 1
- The risk of abuse and addiction associated with certain muscle relaxers, such as carisoprodol (Soma) 1
- The importance of monitoring patients for signs of hepatotoxicity when using certain muscle relaxers, such as tizanidine (Zanaflex) and chlorzoxazone 1
Overall, cyclobenzaprine (Flexeril) is a reasonable option for patients who require a muscle relaxer with a lower sedation profile, but it's essential to weigh the potential benefits and risks and consider individual patient factors when making treatment decisions 1.
From the Research
Least Sedating Muscle Relaxers
- Methocarbamol and metaxalone are considered to be less sedating compared to other muscle relaxants 2
- Cyclobenzaprine is the most heavily studied muscle relaxant and has been shown to be effective for various musculoskeletal conditions, but it has sedative properties 2
- Tizanidine is a central alpha 2 adrenoceptor agonist that is used to treat spasticity, and while it can cause drowsiness, it is considered to have a more favorable tolerability profile compared to baclofen 3, 4
Comparison of Muscle Relaxants
- There is fair evidence that baclofen, tizanidine, and dantrolene are effective compared to placebo in patients with spasticity 4
- Cyclobenzaprine, carisoprodol, orphenadrine, and tizanidine have been shown to be effective compared to placebo in patients with musculoskeletal conditions 4
- The choice of muscle relaxant should be based on side-effect profile, patient preference, abuse potential, and possible drug interactions 2