Is Soma (carisoprodol) a controlled substance?

Carisoprodol (Soma) Controlled Substance Status

Yes, carisoprodol (Soma) is a Schedule IV controlled substance under federal law due to its significant abuse potential, risk of dependence, and withdrawal syndrome.1

Classification and Regulatory Status

• Carisoprodol was classified as a Schedule IV controlled substance by the FDA due to:
  • Documented history of abuse, misuse, and criminal diversion for non-therapeutic use1
  • Potential to cause physical dependence and withdrawal symptoms2
  • Metabolization to meprobamate, which is also a controlled substance1

Abuse Potential and Risks

• Abuse of carisoprodol poses serious risks:

  • CNS and respiratory depression
  • Hypotension
  • Seizures
  • Potential for overdose which may lead to death1

• Carisoprodol has barbiturate-like properties and central nervous system depressant effects that contribute to its abuse potential2

• The sedative effects of carisoprodol can be additive with other CNS depressants (alcohol, benzodiazepines, opioids), increasing risk of adverse outcomes1

Dependence and Withdrawal

• Physical dependence can develop with prolonged use, characterized by withdrawal symptoms after abrupt discontinuation1

• Reported withdrawal symptoms include:

  • Insomnia
  • Vomiting
  • Abdominal cramps
  • Headache
  • Tremors and muscle twitching
  • Anxiety
  • Ataxia
  • Hallucinations and psychosis1

• Patients taking large doses or using the drug for prolonged periods should not abruptly stop carisoprodol1

Clinical Prescribing Guidelines

• Carisoprodol should only be used for short-term treatment (up to 2-3 weeks) for acute, painful musculoskeletal conditions2

• Before prescribing, clinicians should:

  • Assess risk of abuse
  • Limit treatment duration to three weeks
  • Keep careful prescription records
  • Monitor for signs of abuse and overdose1

• Warning signs of potential abuse include:

  • Patients requesting the drug by name
  • Reports of "lost" prescriptions
  • Chronic use beyond recommended duration
  • Refusal of alternative treatments with lower abuse potential2

Precautions and Contraindications

• Exercise caution in patients with:

  • History of substance abuse
  • Those using other CNS depressants
  • Patients requiring operation (should hold medication on day of surgery)2

• Avoid co-prescription with opioids and benzodiazepines due to increased mortality risk2

• Consider alternative therapies with better safety profiles for musculoskeletal pain, such as NSAIDs or other muscle relaxants with lower abuse potential2

The controlled substance status of carisoprodol reflects the recognition of its significant abuse potential and the need for careful monitoring when prescribed clinically.