Cyclobenzaprine Tapering Schedule
Cyclobenzaprine should be tapered over 2-3 weeks by reducing the dose by approximately 25-30% of the original dose in week 1,50% in week 2, and 25% in week 3 before complete discontinuation to prevent withdrawal symptoms. 1
Rationale for Tapering
Cyclobenzaprine is a centrally acting skeletal muscle relaxant that can cause withdrawal symptoms when discontinued abruptly, particularly after prolonged use. These symptoms may include:
- Malaise
- Nausea
- Headache
- Rebound muscle spasm or pain
- Sleep disturbances
- Mood changes
Recommended Tapering Schedule
Based on the most recent and highest quality evidence from the Mayo Clinic 1, the following tapering schedule is recommended:
Week 1:
- Reduce dose by 25-30% of original dose
Week 2:
- Reduce to 50% of original dose
Week 3:
- Reduce to 25% of original dose
Week 4:
- Complete discontinuation
Example of Tapering Schedule
For a patient on cyclobenzaprine 10 mg three times daily (30 mg total daily dose):
- Week 1: Reduce to 7.5 mg three times daily (22.5 mg total daily dose)
- Week 2: Reduce to 5 mg three times daily (15 mg total daily dose)
- Week 3: Reduce to 2.5 mg three times daily (7.5 mg total daily dose)
- Week 4: Discontinue
Monitoring During Tapering
During the tapering process, it's important to monitor for:
- Rebound muscle spasm or pain
- Withdrawal symptoms (malaise, nausea, headache)
- Sleep disturbances
- Mood changes
Special Considerations
- Duration of Use: The Society for Perioperative Assessment and Quality Improvement (SPAQI) recommends limiting cyclobenzaprine use to short-term relief (≤21 days) for acute muscle spasm 1
- Driving Safety: Patients should be cautioned about operating heavy machinery or driving while taking cyclobenzaprine as it significantly impairs driving ability 1
- Concomitant Medications: Exercise caution when tapering cyclobenzaprine in patients also taking monoamine oxidase inhibitors due to increased risk of serotonin syndrome 1
Efficacy Considerations
It's worth noting that cyclobenzaprine is primarily effective for short-term relief of acute low back pain, with onset of relief apparent within 3-4 doses of the 5 mg regimen 1, 2. The European League Against Rheumatism (EULAR) gives only a weak recommendation for cyclobenzaprine use in fibromyalgia, noting small effects on sleep and pain 1.
For patients requiring longer-term management of musculoskeletal pain, alternative treatments should be considered after completing the cyclobenzaprine taper.