Can I resume taking my muscle (muscle) relaxer, specifically Flexeril (cyclobenzaprine), to manage my nocturnal leg cramps?

From the Guidelines

I strongly advise against resuming Flexeril (cyclobenzaprine) for nocturnal leg cramps without consulting your healthcare provider first, as it is primarily indicated for acute, painful musculoskeletal conditions and not FDA-approved for treating leg cramps. While it might help with muscle spasms temporarily, it's not an appropriate long-term solution for nocturnal leg cramps. Side effects can include drowsiness, dry mouth, dizziness, and it may interact with other medications you're taking. According to a study published in the Annals of the Rheumatic Diseases 1, cyclobenzaprine has a high rate of side effects, with 85% of patients experiencing adverse effects, and only 71% completing the studies. For nocturnal leg cramps, better first-line approaches include:

• Stretching before bedtime
• Staying hydrated
• Maintaining adequate electrolyte levels (particularly magnesium and potassium)
• Ensuring proper positioning while sleeping If your leg cramps are severe or persistent, your doctor might recommend specific treatments tailored to your medical history and needs, which could include different medications that are more appropriate for this condition. It's essential to weigh the potential benefits and harms of any medication, especially considering the risks associated with long-term use of skeletal muscle relaxants, as discussed in a study published in the Annual Review of Medicine 1. Therefore, it's crucial to consult with your healthcare provider to determine the best course of treatment for your nocturnal leg cramps.

From the FDA Drug Label

Cyclobenzaprine hydrochloride tablets are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions Cyclobenzaprine hydrochloride tablets should be used only for short periods (up to two or three weeks) because adequate evidence of effectiveness for more prolonged use is not available

The answer to your question is: No, you should not resume taking your muscle relaxer, specifically Flexeril (cyclobenzaprine), for an extended period to manage your nocturnal leg cramps, as the FDA label indicates it should only be used for short periods (up to two or three weeks) for acute, painful musculoskeletal conditions 2.

From the Research

Resuming Muscle Relaxer Use for Nocturnal Leg Cramps

• The decision to resume taking a muscle relaxer, specifically Flexeril (cyclobenzaprine), for managing nocturnal leg cramps should be based on the potential benefits and risks associated with its use 3, 4.
• Cyclobenzaprine has been shown to be effective in improving muscle spasm, reducing local pain and tenderness, and increasing range of motion in acute, painful musculoskeletal conditions 3.
• However, it is also associated with sedative effects, which may be beneficial for patients experiencing nocturnal leg cramps, but can also lead to adverse events such as drowsiness and dizziness 4, 5.

Efficacy and Safety of Cyclobenzaprine

• Studies have demonstrated that cyclobenzaprine is effective in reducing muscle spasm and pain, with a rapid onset of action 3, 6.
• The safety profile of cyclobenzaprine is generally favorable, with somnolence and dry mouth being the most common adverse effects, which are mild and dose-related 3.
• However, the use of cyclobenzaprine has also been associated with a higher incidence of sedation, particularly at higher doses 3, 4.

Alternative Therapies for Nocturnal Leg Cramps

• Non-drug therapies, such as stretching, may be effective in reducing the severity and frequency of nocturnal leg cramps 7.
• A combination of daily calf and hamstring stretching for six weeks may reduce the severity of night-time lower limb muscle cramps in people aged 55 years and older 7.
• However, the evidence for the effectiveness of non-drug therapies is limited, and more research is needed to fully understand their benefits and risks 7.

Considerations for Resuming Cyclobenzaprine Use

• Patients should carefully weigh the potential benefits and risks of resuming cyclobenzaprine use, particularly if they have experienced adverse events in the past 3, 4, 5.
• The dosage and duration of cyclobenzaprine use should be carefully considered, as higher doses and longer durations of use may increase the risk of adverse events 3, 4.
• Patients should also be aware of the potential for sedative effects and take necessary precautions to minimize their impact on daily activities 4, 5.