What is the dose and frequency of Cyclobenzaprine (Flexeril)?

From the Guidelines

Flexeril (cyclobenzaprine) should be prescribed at a dose of 5-10 mg taken three times daily for adults, with a maximum recommended daily dose of 30 mg, as this dosage has been found to provide moderate short-term pain relief for acute low back pain 1.

Key Considerations

• For elderly patients or those with liver impairment, starting at a lower dose of 5 mg is advisable to minimize potential side effects.
• The medication is generally prescribed for short-term use, usually 2-3 weeks, as its effectiveness beyond this period hasn't been established and to minimize side effects 1.
• Flexeril works as a muscle relaxant by acting on the central nervous system to reduce muscle hyperactivity without affecting muscle function directly.

Important Safety Information

• It's crucial to take this medication exactly as prescribed, avoiding alcohol and other CNS depressants while using it, as these combinations can increase drowsiness and impair coordination.
• Common side effects include drowsiness, dry mouth, and dizziness, which is why it's often recommended to take it before bedtime and avoid driving or operating machinery until you know how it affects you.
• If muscle spasms persist beyond the prescribed treatment period, consult your healthcare provider rather than continuing the medication independently.

Evidence Summary

• A higher-quality Cochrane review found skeletal muscle relaxants, including cyclobenzaprine, to be moderately superior to placebo for short-term pain relief in acute low back pain 1.
• However, there was insufficient evidence to conclude that any specific muscle relaxant is superior to others for benefits or harms 1.

From the FDA Drug Label

For most patients, the recommended dose of cyclobenzaprine hydrochloride tablets is 5 mg three times a day. Based on individual patient response, the dose may be increased to 10 mg three times a day. The recommended dose of Cyclobenzaprine is:

• 5 mg three times a day for most patients
• Up to 10 mg three times a day based on individual patient response The recommended frequency is three times a day 2

From the Research

Dose and Frequency of Cyclobenzaprine

The dose and frequency of Cyclobenzaprine (Flexeril) can vary depending on the specific condition being treated and the formulation of the medication.

• For acute skeletal muscle spasm, Cyclobenzaprine hydrochloride can be administered at a dose of 5 mg or 10 mg three times a day (TID) 3.
• A lower dose of 2.5 mg TID may not be as effective as the 5 mg or 10 mg doses 3.
• For muscle spasm associated with low back and neck pain, Cyclobenzaprine extended release (CER) can be administered at a dose of 15 mg or 30 mg once daily 4.
• Cyclobenzaprine immediate release (CIR) can be administered at a dose of 10 mg three times a day (TID) 4, 5.

Efficacy and Safety

The efficacy and safety of Cyclobenzaprine have been evaluated in several studies.

• Cyclobenzaprine 5 mg TID was found to be as effective as 10 mg TID, with a lower incidence of sedation 3.
• CER 15 mg and 30 mg once daily were found to be effective in treating muscle spasm associated with painful musculoskeletal conditions, with a lower rate of somnolence compared to CIR 10 mg TID 4, 5.
• The most common adverse events associated with Cyclobenzaprine include somnolence, dry mouth, dizziness, headache, and constipation 3, 4, 5.