From the Guidelines
Cyclobenzaprine is typically prescribed at a dose of 5-10 mg three times daily for adults, with a maximum recommended daily dose of 30 mg. This recommendation is based on the available evidence, including a systematic review published in the Annals of Internal Medicine 1. For elderly patients or those with liver impairment, starting at a lower dose of 5 mg is advisable due to potential increased sensitivity to the medication's sedative effects.
Key Considerations
- The medication should be used for short-term treatment, generally 2-3 weeks, as its effectiveness beyond this period hasn't been established and to minimize side effects, such as sedation and diarrhea, which were reported in trials comparing different medications for low back pain 1.
- Cyclobenzaprine works as a muscle relaxant by acting on the central nervous system to reduce muscle hyperactivity without affecting muscle function.
- It's essential to take this medication exactly as prescribed and be aware of common side effects, including drowsiness, dry mouth, and dizziness.
- Patients should avoid alcohol and other CNS depressants while taking cyclobenzaprine, as these combinations can intensify sedative effects.
- The medication should be taken with food if stomach upset occurs, and patients should not abruptly discontinue use after prolonged treatment to avoid withdrawal symptoms.
Safety and Efficacy
- Skeletal muscle relaxants, including cyclobenzaprine, were found to be moderately superior to placebo for short-term pain relief in acute low back pain, with a relative risk of not achieving pain relief of 0.80 (CI, 0.71 to 0.89) at 2 to 4 days 1.
- However, there is limited evidence on the efficacy of cyclobenzaprine for chronic low back pain, with only one lower-quality trial reporting mixed results compared to placebo 1.
- Cyclobenzaprine and other skeletal muscle relaxants were associated with a higher total number of adverse events and central nervous system adverse events compared to placebo, although most events were self-limited and serious complications were rare 1.
From the FDA Drug Label
For most patients, the recommended dose of cyclobenzaprine hydrochloride tablets is 5 mg three times a day. Based on individual patient response, the dose may be increased to 10 mg three times a day. The recommended dosing for Cyclobenzaprine (Flexeril) is:
- 5 mg three times a day for most patients
- May be increased to 10 mg three times a day based on individual patient response 2
From the Research
Recommended Dosing for Cyclobenzaprine (Flexeril)
The recommended dosing for Cyclobenzaprine (Flexeril) can vary depending on the specific formulation and the patient's condition.
- For immediate-release Cyclobenzaprine, a common dosage is 10 mg three times daily 3.
- However, studies have shown that a lower dose of 5 mg three times daily can be effective with less sedation 3.
- For extended-release Cyclobenzaprine, a dosage of 30 mg once daily has been shown to be effective and well-tolerated 4, 5, 6.
- A lower dose of 15 mg once daily has also been studied, but may not be as effective as the 30 mg dose 6.
Factors Affecting Dosing
Several factors can affect the dosing of Cyclobenzaprine, including:
- Age: Elderly patients may require lower doses due to increased systemic exposure 5.
- Food: Taking Cyclobenzaprine with food can increase systemic exposure 5.
- Condition: The specific condition being treated, such as acute muscle spasm, can affect the dosing regimen 3, 6.
Comparison of Formulations
Studies have compared the efficacy and tolerability of different Cyclobenzaprine formulations, including: