Cyclobenzaprine Dosing
For most patients, start cyclobenzaprine at 5 mg three times daily, which can be increased to 10 mg three times daily based on response, but limit treatment duration to 2-3 weeks maximum. 1
Standard Dosing Regimen
- Initial dose: 5 mg three times daily (TID) is the FDA-recommended starting point for most patients 1
- Titration: May increase to 10 mg TID if the 5 mg dose provides insufficient relief 1
- Duration: Limit use to 2-3 weeks as efficacy and safety beyond this timeframe are not established 1
The 5 mg TID regimen is as effective as 10 mg TID for muscle spasm relief but causes significantly less sedation, making it the preferred starting dose 2. Clinical trials demonstrated that 5 mg TID produces meaningful symptom improvement with onset of relief apparent within 3-4 doses 2.
Extended-Release Formulation Alternative
- Cyclobenzaprine ER: 15-30 mg once daily is an alternative that provides comparable efficacy to immediate-release formulations 3
- The ER formulation produces a single daily peak concentration (median tmax ~6-8 hours) versus three peaks with immediate-release, potentially reducing fluctuations in side effects 4, 5
- CER 30 mg once daily provides systemic exposure equivalent to CIR 10 mg TID 4
Special Population Adjustments
Elderly Patients (≥65 years)
- Use less frequent dosing in elderly patients due to altered pharmacokinetics 1
- Systemic exposure is increased in elderly subjects, necessitating dose reduction 5, 6
- Cyclobenzaprine appears on the Beers Criteria as potentially inappropriate for older adults due to anticholinergic effects (dry mouth, drowsiness, constipation) 7
Hepatic Impairment
- Reduce dosing frequency in patients with hepatic impairment 1
- Consider starting at the lowest effective dose given altered drug metabolism
Critical Prescribing Caveats
- Do NOT use cyclobenzaprine for chronic musculoskeletal pain - it is not indicated for chronic conditions and lacks long-term efficacy data 8
- Avoid in patients taking MAO inhibitors due to risk of serotonin syndrome 7
- Taper over 2-3 weeks when discontinuing after extended use to prevent withdrawal symptoms, though tolerance to therapeutic effects does not develop 7, 9
- Sedation is dose-related - somnolence occurred in 54-62% of patients on 5-10 mg versus 35% on placebo 2
- The 2.5 mg TID dose is not effective and should not be used 2
Common Pitfall to Avoid
The most frequent prescribing error is continuing cyclobenzaprine beyond 2-3 weeks. Despite the absence of tolerance development to therapeutic effects 9, prolonged use is not recommended because efficacy data beyond this timeframe are lacking, and anticholinergic side effects persist without diminishing 9. The drug should be reserved strictly for acute painful musculoskeletal conditions with muscle spasm 1.