From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For patients with Alzheimer's disease who require muscle relaxation, tizanidine (Zanaflex) is often considered the best option, typically starting at 2mg once or twice daily and gradually increasing as needed up to 8mg three times daily. Tizanidine is preferred because it has minimal cognitive side effects compared to other muscle relaxants, which is crucial for Alzheimer's patients who already experience cognitive impairment 1. Baclofen is generally avoided as it can worsen confusion and cognitive function. When prescribing any muscle relaxant for these patients, it's essential to start with the lowest possible dose and monitor closely for side effects such as sedation, dizziness, or increased confusion. Some key points to consider when prescribing muscle relaxants for Alzheimer's patients include:
- Non-pharmacological approaches should be tried first, including physical therapy, gentle stretching exercises, and warm compresses.
- The underlying cause of muscle spasticity should also be identified and addressed when possible.
- Regular reassessment is necessary to determine if the medication remains beneficial and to minimize the duration of treatment. It's also important to note that the use of muscle relaxants has been associated with an increased risk of Alzheimer's disease, particularly with longer use and higher exposure to certain medications like orphenadrine 1. However, tizanidine was not found to be associated with an increased risk of Alzheimer's disease, making it a safer option for patients who require muscle relaxation 1. Overall, the goal of treatment should be to minimize symptoms and improve quality of life while minimizing the risk of adverse effects and interactions with other medications.