Tizanidine for Insomnia Treatment
Tizanidine is not recommended for treating insomnia as it lacks sufficient evidence for efficacy and safety in this indication, and is not included in any major insomnia treatment guidelines. 1
First-Line Treatment Recommendations for Insomnia
- Cognitive Behavioral Therapy for Insomnia (CBT-I) is strongly recommended as the first-line treatment for chronic insomnia by both the American Academy of Sleep Medicine and American College of Physicians 1, 2
- CBT-I is more effective than pharmacotherapy in the long term and has fewer adverse effects 2
- Brief Behavioral Treatment for Insomnia (BBT-I) can also be effective for treating insomnia 2
Recommended Pharmacological Options for Insomnia
When medication is necessary after CBT-I has been unsuccessful:
- First-line pharmacological options include short-intermediate acting benzodiazepine receptor agonists (BZRAs) or ramelteon 1, 2
- Second-line option is low-dose doxepin (3 or 6 mg) 1, 2
- Third-line options include sedating antidepressants (trazodone, amitriptyline, doxepin, mirtazapine) particularly for patients with comorbid depression or anxiety 1, 2
Tizanidine and Sleep
- Tizanidine is a centrally acting alpha-2 adrenergic agonist approved for the treatment of spasticity, not insomnia 3, 4
- While tizanidine causes drowsiness as a side effect, this does not constitute evidence for its efficacy as an insomnia treatment 3, 4
- Limited evidence exists only for tizanidine's use in sleep disturbances specifically in children with spastic quadriplegia, which cannot be generalized to the broader insomnia population 5
- No major insomnia treatment guidelines from the American Academy of Sleep Medicine or American College of Physicians include tizanidine as a recommended treatment for insomnia 1, 2
Safety Concerns with Tizanidine
- Tizanidine can cause significant adverse effects including hypotension, bradycardia, and altered mental status 6
- Overdose of tizanidine can lead to serious complications requiring intensive supportive care 6
- Using medications off-label without sufficient evidence of efficacy and safety is not recommended, especially when FDA-approved alternatives exist 1
Important Considerations for Insomnia Treatment
- FDA has approved pharmacological treatments for insomnia only for short-term use (4-5 weeks) 1
- Over-the-counter antihistamines and herbal supplements are not recommended for chronic insomnia due to lack of efficacy and safety data 1, 2
- Older medications and those not specifically indicated for insomnia should be avoided due to unfavorable risk-benefit profiles 1, 2
- Pharmacotherapy should be supplemented with behavioral and cognitive therapies whenever possible 2