Maximum Recommended Daily Dose of Cyclobenzaprine
The maximum recommended daily dose of cyclobenzaprine is 30 mg per day, typically administered as 10 mg three times daily. 1
Dosing Guidelines
- The FDA-approved dosing for cyclobenzaprine is 5 mg three times daily, which can be increased to 10 mg three times daily based on individual patient response 1
- Treatment duration should not exceed two to three weeks, as longer use is not recommended 1
- Lower doses should be considered for elderly patients and those with hepatic impairment 1
Formulations and Alternative Dosing
- Standard immediate-release formulation (CIR): 10 mg three times daily (maximum 30 mg/day) 2
- Extended-release formulation (CER): available as a once-daily 30 mg dose, which provides comparable systemic exposure to the immediate-release 10 mg three times daily regimen 3, 4
- Lower dose regimens (5 mg three times daily) have been shown to be as effective as 10 mg three times daily with fewer sedative effects 2
Special Populations
- Elderly patients (65-75 years): Require dose adjustment due to potential for altered pharmacokinetics; lower doses are recommended 1, 5
- Patients with hepatic impairment: Should receive less frequent dosing due to potential for drug accumulation 1
Clinical Considerations
- Cyclobenzaprine is structurally related to tricyclic antidepressants and has anticholinergic effects 6
- Common adverse effects include sedation and dry mouth, which are dose-related 2
- The drug has a half-life of 18 hours, with steady-state plasma concentrations achieved after 3-4 days of dosing 4
- Extended-release formulations provide more consistent plasma levels compared to the multiple peaks and troughs seen with immediate-release formulations 3
Cautions and Contraindications
- Long-term use can lead to dependence and withdrawal symptoms; tapering over 2-3 weeks is recommended when discontinuing after extended use 6
- Cyclobenzaprine appears on the American Geriatrics Society Beers Criteria® as potentially inappropriate for older adults due to anticholinergic effects 6
- Concomitant use with monoamine oxidase inhibitors may increase the risk of serotonin syndrome 6
Efficacy Considerations
- Studies show that 5 mg three times daily is often as effective as 10 mg three times daily with fewer side effects 2
- For acute muscle spasm, onset of relief is typically apparent within 3-4 doses of the 5 mg regimen 2
- Extended-release formulations (30 mg once daily) show similar efficacy to immediate-release (10 mg three times daily) with potentially less daytime drowsiness 7
Remember that cyclobenzaprine is intended for short-term use only (2-3 weeks maximum), and the lowest effective dose should be used to minimize side effects while maintaining efficacy.