How to taper off cyclobenzaprine when taking 10 mg three times a day?

How to Taper Cyclobenzaprine 10 mg TID

Cyclobenzaprine should be tapered gradually over 2 to 3 weeks to prevent withdrawal symptoms. 1

Understanding Cyclobenzaprine and Withdrawal

Cyclobenzaprine is an oral centrally acting 5-HT2 receptor antagonist that functions as a skeletal muscle relaxant and is structurally related to amitriptyline. 1 It has both peripheral and central anticholinergic activity and can cause norepinephrine potentiation. 1

• With long-term use, patients can experience withdrawal symptoms including malaise, nausea, and headache for 2-4 days after discontinuation. 1
• Although these withdrawal symptoms are uncomfortable, they are not life-threatening, unlike some other muscle relaxants. 1
• Tapering helps minimize these withdrawal symptoms while safely discontinuing the medication. 1

Recommended Tapering Schedule

For a patient on cyclobenzaprine 10 mg three times daily (30 mg total daily dose), follow this tapering schedule:

Week 1:

• Reduce to 10 mg twice daily and 5 mg once daily (25 mg total) 1

Week 2:

• Reduce to 5 mg three times daily (15 mg total) 1

Week 3:

• Reduce to 5 mg twice daily (10 mg total) 1

Week 4:

• Reduce to 5 mg once daily (5 mg total) 1
• Then discontinue completely 1

Monitoring During Tapering

• Watch for withdrawal symptoms including malaise, nausea, and headache 1
• Monitor for rebound muscle spasm or pain 1
• If withdrawal symptoms become problematic, slow the taper by extending each step to 10-14 days 1

Special Considerations

• If the patient is elderly or has hepatic or renal dysfunction, consider a more gradual taper as these patients may be more sensitive to medication changes 1
• Be aware of potential drug interactions, especially with other CNS depressants, which may complicate the tapering process 1
• Avoid concurrent use with monoamine oxidase inhibitors due to risk of serotonin syndrome 1

Alternative Approaches

• For patients experiencing significant withdrawal symptoms, consider adjunctive medications to manage specific symptoms:

  • For anxiety or insomnia: short-term use of trazodone or gabapentin 1
  • For gastrointestinal discomfort: standard anti-nausea medications 1

• Some patients may benefit from switching to cyclobenzaprine extended-release formulation (CER) before tapering, as it provides more consistent plasma levels with once-daily dosing 2, 3

Common Pitfalls to Avoid

• Avoid abrupt discontinuation, which increases risk of withdrawal symptoms 1
• Don't taper too quickly in patients who have been on long-term therapy 1
• Be aware that withdrawal symptoms might be mistaken for recurrence of the original muscle spasm condition 4
• Remember that lower doses (2.5 mg TID) may not be effective for symptom control during tapering 5