From the Guidelines
Cyclobenzaprine and Tizanidine have similar efficacy for treating muscle spasms, with insufficient evidence to conclude that one is superior to the other.
Key Points
- Both Cyclobenzaprine and Tizanidine are skeletal muscle relaxants used to treat muscle spasms, with Tizanidine being efficacious for acute low back pain in 8 trials 1.
- There is insufficient evidence to conclude that any specific muscle relaxant is superior to others for benefits or harms 1.
- Skeletal muscle relaxants, including Cyclobenzaprine and Tizanidine, are associated with a higher total number of adverse events and central nervous system adverse events compared with placebo 1.
- The duration of therapy in all trials was 2 weeks or less, with the exception of a single 3-week trial, and most events were self-limited and serious complications were rare 1.
Efficacy Comparison
- Tizanidine was found to be efficacious for acute low back pain in 8 trials, while Cyclobenzaprine had mixed results in 2 lower-quality trials for chronic or subacute low back or neck pain 1.
- There is only sparse evidence on the efficacy of Cyclobenzaprine for chronic low back pain, with only 1 lower-quality trial evaluating its effectiveness 1.
From the Research
Comparative Efficacy of Cyclobenzaprine and Tizanidine
- The comparative efficacy of Cyclobenzaprine versus Tizanidine for treating muscle spasms has been evaluated in several studies 2, 3.
- Cyclobenzaprine has been found to be effective in improving muscle spasm, reducing local pain and tenderness, and increasing range of motion in acute, painful musculoskeletal conditions 4.
- Tizanidine has also been shown to be effective in treating spasticity and musculoskeletal conditions, with fair evidence suggesting its efficacy compared to placebo 2.
- However, there is limited data directly comparing the efficacy of Cyclobenzaprine and Tizanidine, with one review suggesting that Cyclobenzaprine has been evaluated in the most clinical trials and has consistently been found to be effective 2.
- Another study notes that the choice of skeletal muscle relaxant, including Cyclobenzaprine and Tizanidine, should be based on side-effect profile, patient preference, abuse potential, and possible drug interactions, as there is no clear evidence of one being superior to the other 3.
Safety and Adverse Effects
- Both Cyclobenzaprine and Tizanidine have been associated with adverse effects, including sedation, dizziness, and dry mouth 4, 2, 3.
- Cyclobenzaprine has been found to have a dose-related incidence of somnolence and dry mouth, with a lower dose of 5 mg TID associated with a lower incidence of sedation compared to 10 mg TID 4.
- Tizanidine has been associated with more dry mouth compared to baclofen, another skeletal muscle relaxant 2.
Clinical Use
- Cyclobenzaprine and Tizanidine are both used to treat musculoskeletal conditions, including acute back or neck pain, and spasticity 2, 3.
- The sedative properties of these drugs may be beneficial for patients with insomnia caused by severe muscle spasms 3.
- However, the potential adverse effects should be communicated clearly to the patient, and the choice of agent should be based on individual patient needs and preferences 3.