From the Guidelines
Tizanidine is primarily used as a muscle relaxant to treat muscle spasms, cramping, and tightness caused by conditions such as multiple sclerosis, spinal cord injuries, or other musculoskeletal disorders, including spasticity in chronic stroke patients 1.
Uses of Tizanidine
The medication is typically prescribed at a starting dose of 2-4 mg taken as needed, up to three times daily, with gradual increases as tolerated to a maximum of 36 mg per day divided into multiple doses.
Mechanism of Action
Tizanidine works by acting as an alpha-2 adrenergic agonist in the central nervous system, which reduces the release of excitatory neurotransmitters and decreases muscle tone and spasticity.
Efficacy and Safety
According to a higher-quality Cochrane review, skeletal muscle relaxants, including tizanidine, are moderately superior to placebo for short-term pain relief in acute low back pain 1. However, there is only sparse evidence on the efficacy of tizanidine for chronic low back pain.
Side Effects and Interactions
Common side effects of tizanidine include drowsiness, dizziness, dry mouth, and hypotension. Patients should be aware that tizanidine can interact with several medications, particularly CYP1A2 inhibitors like ciprofloxacin and fluvoxamine, which can significantly increase tizanidine blood levels 1.
Special Considerations
It should be used cautiously in patients with liver or kidney impairment, and alcohol should be avoided during treatment as it can enhance sedative effects. Tizanidine should be tapered gradually when discontinuing to prevent rebound hypertension or tachycardia. Some key points to consider when prescribing tizanidine include:
- Starting with a low dose and gradually increasing as needed and tolerated
- Monitoring for side effects, particularly drowsiness and dizziness
- Avoiding concomitant use with CYP1A2 inhibitors
- Tapering the dose gradually when discontinuing treatment
- Using cautiously in patients with liver or kidney impairment
- Avoiding alcohol consumption during treatment
From the FDA Drug Label
Tizanidine is a short-acting drug for the management of spasticity. The main use of Tizanidine (Zanaflex) is for the management of spasticity.
- Key points about its use:
- It is a short-acting drug
- Treatment with tizanidine should be reserved for those daily activities and times when relief of spasticity is most important 2
From the Research
Uses of Tizanidine (Zanaflex)
- Tizanidine is used in the treatment of spasticity in patients with cerebral or spinal injury 3
- It is effective in reducing spasticity caused by multiple sclerosis (MS), acquired brain injury, or spinal cord injury 4, 5, 6
- Tizanidine has also been shown to be clinically effective in the management of pain syndromes, such as:
- Myofascial pain
- Lower back pain
- Trigeminal neuralgia 5
- It can be helpful in patients suffering from chronic neck and/or lower back pain who have a myofascial component to their pain 5
- Tizanidine is used as an adjunct in the treatment of spasticity in patients with multiple sclerosis, with preference tempered by side-effects 7