Administration of Muscle Relaxants with Regard to Food and Timing

Most muscle relaxants should be taken consistently with regard to food and timing, with specific recommendations varying by medication type.

Cyclobenzaprine (Flexeril)

Hold on the day of surgery due to potential interactions with anesthetics and sedatives 1
Typically administered three times daily (TID) for optimal therapeutic effect 2
Can be taken with or without food, though taking with food may help reduce gastrointestinal side effects 3
For acute musculoskeletal conditions, 5 mg TID is as effective as 10 mg TID with fewer sedative effects 2
When discontinuing after long-term use, implement a gradual taper over 2-3 weeks to prevent withdrawal symptoms including malaise, nausea, and headache 3

Can be taken with or without food as studies show food does not significantly influence either the rate or extent of absorption 4
Taking with food or milk may help minimize gastrointestinal side effects without affecting clinical response 4
Start with a low dose and gradually increase to minimize common side effects of dizziness, somnolence, and gastrointestinal symptoms 1
Discontinuation after prolonged use requires a slow tapering period to avoid withdrawal symptoms 1

Should be taken consistently including the day of surgical procedures 1
May cause significant sedative and hypotensive effects, particularly in elderly patients 1
If discontinuation is needed after long-term use, the dose should be tapered slowly to prevent withdrawal symptoms including rebound tachycardia, hypertension, and hypertonia 1

Hold on day of operation 1
If time permits before surgical procedures, consider tapering off or switching to an alternative agent 1
Has substantial abuse potential and is classified as a controlled substance 1
Should be tapered slowly (over 4 to 9 days) rather than stopped abruptly to avoid severe withdrawal symptoms 1

Hold on day of operation 1
Has multiple central nervous system adverse effects including drowsiness, dizziness, and irritability 1
Contraindicated in patients with significant hepatic or renal dysfunction 1

Hold on day of operation 1
Can cause adverse effects including drowsiness, dizziness, bradycardia, and hypotension 1
Elimination is significantly impaired in patients with liver and kidney disease 1

Effects are nonspecific and not directly related to muscle relaxation 1
Many of these drugs may be associated with greater risk for falls, particularly in older persons 1
Sedation is the most common adverse effect and is dose-related 2, 5
Consider timing administration to avoid interference with daily activities requiring alertness 5
For most muscle relaxants, consistent timing throughout the day helps maintain therapeutic blood levels 2

In older adults, muscle relaxants are considered potentially inappropriate medications due to anticholinergic effects and sedation 3
Avoid abrupt discontinuation of any muscle relaxant after prolonged use 1, 3
Monitor for common side effects including dizziness, drowsiness, dry mouth, and gastrointestinal symptoms 3, 5