Is Eperisone Effective for Muscle Sprains?
No, eperisone should not be used for acute muscle sprains in healthy adults—oral NSAIDs or acetaminophen are the evidence-based first-line treatments recommended by major clinical guidelines. 1
Why Eperisone Is Not Recommended
The 2020 American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) clinical guideline on acute musculoskeletal injuries—which specifically includes muscle sprains—makes no mention of eperisone as a treatment option. 1 This comprehensive guideline reviewed 207 trials with nearly 33,000 patients and provides the definitive evidence-based approach to managing these injuries. 1
What the Guidelines Actually Recommend
For acute muscle sprains, the ACP/AAFP guideline recommends:
- Oral NSAIDs as first-line pharmacologic treatment to reduce pain and improve physical function (moderate-certainty evidence) 1
- Oral acetaminophen as an alternative to reduce pain (moderate-certainty evidence) 1
- Specific acupressure or TENS as nonpharmacologic options (low-certainty evidence) 1
- Against using opioids including tramadol (conditional recommendation) 1
The Problem with "Muscle Relaxants" Generally
The term "muscle relaxant" is misleading for drugs like eperisone. Most muscle relaxants do not directly relax skeletal muscle and have no evidence of efficacy in chronic pain. 2 The American Geriatrics Society explicitly states that muscle relaxants as a class are potentially inappropriate medications due to anticholinergic effects, sedation, and increased fall risk. 2
Traditional muscle relaxants are not preferred for acute musculoskeletal pain according to current guidelines. 1 When muscle relaxants are considered at all, they are reserved for true muscle spasm or spasticity (not simple strains/sprains), and even then, agents like baclofen or tizanidine are preferred over other options. 2, 3
Eperisone-Specific Concerns
While eperisone is marketed as having fewer CNS side effects than traditional muscle relaxants 4, 5, this does not make it appropriate for muscle sprains:
Limited Evidence Base
- The available research on eperisone consists primarily of open-label studies in low back pain populations 5, 6—not the acute muscle sprain population addressed in your question
- These studies lack the rigor of the randomized controlled trials that inform current guidelines 5, 6
Safety Issues
- Eperisone can cause anaphylaxis with an incidence of 0.001%, comprising 16.9% of all eperisone-related adverse drug reactions in Korean pharmacovigilance data 7
- All patients who underwent oral provocation testing for suspected eperisone-induced anaphylaxis had positive reactions 7
- Severe reactions including laryngeal edema and hypotension have been reported 8
Regulatory Status
- The FDA label for eperisone lists only generic indications like "minor aches and pains" 9—it does not have specific approval or evidence for acute muscle sprains
The Evidence-Based Approach to Muscle Sprains
Follow this algorithm:
Start with oral NSAIDs (e.g., ibuprofen, naproxen) for pain reduction and improved function—this has moderate-certainty evidence showing pain reduction of approximately 0.93 cm on a 10-cm visual analog scale at <2 hours 1
If NSAIDs are contraindicated, use acetaminophen, which reduces pain by approximately 1.03 cm on a 10-cm scale at <2 hours 1
Consider adding nonpharmacologic treatments like specific acupressure (reduces pain by 1.59 cm at <2 hours) or TENS (reduces pain by 1.94 cm at <2 hours) 1
Avoid opioids including tramadol, as guidelines recommend against their use in this setting 1
Do not prescribe muscle relaxants like eperisone—they are not part of evidence-based care for acute muscle sprains
Critical Pitfalls to Avoid
- Do not assume that because eperisone is called a "muscle relaxant" it is appropriate for muscle sprains—the evidence base does not support this use 1
- Do not be swayed by open-label studies when high-quality guideline evidence exists 5, 6
- Do not overlook the anaphylaxis risk—eperisone has documented severe hypersensitivity reactions 7, 8
- Do not prescribe eperisone in elderly patients—if muscle relaxants are ever needed in older adults, baclofen is the preferred agent, not eperisone 2, 3