Recommended Dosing for Flexeril (Cyclobenzaprine)
For most patients, the recommended dose of cyclobenzaprine is 5 mg three times a day, which may be increased to 10 mg three times a day based on individual response. 1
Standard Dosing Regimen
- Initial dose: 5 mg three times daily
- Maximum dose: 10 mg three times daily if needed based on response
- Duration: Not recommended for use longer than 2-3 weeks 1
Special Populations
Elderly Patients
- Lower doses should be considered due to increased risk of adverse effects 1
- Start with 5 mg three times daily and monitor closely for side effects
Patients with Hepatic Impairment
- Less frequent dosing should be considered 1
- Consider 5 mg twice daily initially
Extended-Release Formulation
If using cyclobenzaprine extended-release (CER):
- 15-30 mg once daily 2
- Provides comparable systemic exposure to immediate-release formulation 3
- May be particularly beneficial for elderly patients 4
Efficacy Considerations
- The 5 mg three times daily regimen has been shown to be as effective as 10 mg three times daily with a lower incidence of sedation 5
- Lower dose of 2.5 mg three times daily has not demonstrated significant effectiveness compared to placebo 5
- Onset of relief is typically apparent within 3-4 doses of the 5 mg regimen 5
Common Side Effects
- Sedation (most common)
- Dry mouth
- Dizziness
- Fatigue
Clinical Pearls
- In fibromyalgia patients, cyclobenzaprine has shown modest improvement in sleep but limited effect on pain 6
- Combination therapy with cyclobenzaprine 5 mg TID plus ibuprofen has not shown superiority to cyclobenzaprine 5 mg TID alone in acute neck and back pain with muscle spasm 7
- Avoid prolonged use as there is no evidence supporting effectiveness beyond 2-3 weeks 1
- Monitor for excessive sedation, particularly when combined with other central nervous system depressants
Monitoring
- Assess for symptom improvement within the first week
- Monitor for side effects, particularly sedation and dry mouth
- Re-evaluate need for continued therapy after 2 weeks
Remember that cyclobenzaprine is intended for short-term use only, and alternative treatments should be considered if symptoms persist beyond the recommended treatment duration.