Indication for Cyclobenzaprine
Cyclobenzaprine is indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions, and should only be used for short periods of 2-3 weeks. 1
FDA-Approved Indication
- Cyclobenzaprine is specifically approved for muscle spasm associated with acute, painful musculoskeletal conditions such as low back pain and neck pain 1
- The medication works to relieve muscle spasm and its associated symptoms including pain, tenderness, limitation of motion, and restriction in activities of daily living 1
- Duration of use must be limited to 2-3 weeks maximum because adequate evidence of effectiveness for more prolonged use does not exist 1
- Muscle spasm associated with acute musculoskeletal conditions is generally of short duration, making longer therapy seldom warranted 1
What Cyclobenzaprine Is NOT Indicated For
- Cyclobenzaprine has not been found effective for spasticity associated with cerebral or spinal cord disease 1
- It is not effective in children with cerebral palsy 1
- It should not be used for chronic musculoskeletal pain beyond 2-3 weeks, as all muscle relaxant trials were 2 weeks or less in duration 2
Evidence for Efficacy
- Skeletal muscle relaxants including cyclobenzaprine are moderately superior to placebo for short-term (2-4 days) pain relief in acute low back pain, with moderate strength of evidence 3
- The 5 mg three times daily dosing is as effective as 10 mg three times daily, with lower sedation rates 4
- Onset of relief occurs within 3-4 doses of the 5 mg regimen 4
- Combination therapy with cyclobenzaprine plus an NSAID (naproxen) results in less objective muscle spasm, less tenderness, and greater range of motion compared to NSAID alone 5
Off-Label Use in Fibromyalgia
- Cyclobenzaprine has shown benefit for fibromyalgia, representing an exception to its typical acute-use indication 6
- This remains an off-label use, as the FDA approval is limited to acute musculoskeletal conditions 1
Common Pitfall to Avoid
The most critical error is prescribing cyclobenzaprine beyond 2-3 weeks, as there is insufficient evidence for chronic use and muscle spasm conditions are typically self-limited 2, 1. Additionally, avoid using cyclobenzaprine for spasticity from upper motor neuron lesions, as it is ineffective for this indication 1.