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 Improvement is manifested by relief of muscle spasm and its associated signs and symptoms, namely, pain, tenderness, limitation of motion, and restriction in activities of daily living Cyclobenzaprine hydrochloride tablets have not been found effective in the treatment of spasticity associated with cerebral or spinal cord disease
The patient has a history of ischemic CVA, and cyclobenzaprine has not been found effective in the treatment of spasticity associated with cerebral disease. Therefore, cyclobenzaprine may not be the best option for this patient.
- Alternative options should be considered, but based on the provided information, no conclusion can be drawn about the safety and efficacy of other muscle relaxants for this patient 1.
From the Research
For a patient with a history of ischemic CVA who is taking Norco and Mobic with morphine available for pain management, baclofen would be an appropriate muscle relaxant choice. Baclofen is typically started at 5 mg three times daily and can be gradually increased to 10-25 mg three times daily as needed and tolerated. This medication is generally well-tolerated in patients with cerebrovascular disease and has minimal interaction with the patient's current pain medications. Tizanidine could be an alternative but requires careful monitoring due to potential hypotensive effects and sedation when combined with opioids like Norco and morphine. Cyclobenzaprine and carisoprodol should be avoided in this patient due to their anticholinergic properties and CNS depression effects, which could increase stroke risk and cause excessive sedation when combined with the patient's current opioid medications. When prescribing baclofen, the patient should be monitored for increased sedation due to the additive CNS depressant effects with opioids, and liver function should be assessed periodically since the patient is also taking acetaminophen and meloxicam.
Some key points to consider when choosing a muscle relaxant for this patient include:
- The potential for sedation and CNS depression with certain muscle relaxants, such as cyclobenzaprine and carisoprodol, which could be exacerbated by concurrent opioid use 2, 3
- The importance of monitoring for increased sedation and assessing liver function periodically when prescribing baclofen to a patient taking opioids and other medications that may affect the liver 4
- The need to carefully weigh the potential benefits and risks of each muscle relaxant option, considering the patient's individual medical history and current medications 5, 6
Overall, the choice of muscle relaxant for a patient with a history of ischemic CVA should prioritize medications with a favorable safety profile and minimal potential for adverse interactions with other medications.