From the Guidelines
For a muscular strain treated with Flexeril (cyclobenzaprine) and ibuprofen, discontinue these medications when pain and muscle spasms have significantly improved, typically within 7-14 days, to minimize the risk of adverse effects and dependence, as suggested by the limited number of available alternative medications or treatments for chronic pain 1. When discontinuing Flexeril, it is essential to taper the medication by taking it once daily for 2-3 days before stopping completely to avoid rebound muscle spasms. Ibuprofen, on the other hand, can be discontinued when pain subsides, usually within 5-7 days. However, it is crucial not to use ibuprofen for longer than 10 days unless directed by a healthcare provider due to potential gastrointestinal, kidney, and cardiovascular side effects with prolonged use, as these medications have anti-inflammatory and antipyretic properties but also inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) which accounts for both their therapeutic and adverse effects 1. Some key points to consider when discontinuing these medications include:
- Gradually return to normal activities while avoiding movements that cause pain
- Apply ice for the first 48-72 hours (15-20 minutes every 2-3 hours), then switch to heat therapy
- Continue gentle stretching and strengthening exercises as tolerated
- Monitor for worsening symptoms, such as pain persisting beyond 2-3 weeks, new symptoms like numbness or weakness, or inability to bear weight, and contact a healthcare provider for reassessment if necessary. It is also important to note that skeletal muscle relaxants, such as Flexeril, are approved for spasticity and musculoskeletal conditions, but most trials have involved acute rather than chronic pain, and there has been concern that some of these medications can lead to abuse and addiction 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Discharge Instructions for Muscular Strain Treated with Flexeril and Ibuprofen
- Rest, ice, compression, and elevation (RICE) should be applied to the affected area to reduce pain and swelling 2
- Nonsteroidal anti-inflammatory drug (NSAID) therapy, such as ibuprofen, should be used to reduce pain and inflammation 2
- Flexeril (cyclobenzaprine) may be prescribed to relieve muscle spasm and pain 3, 4, 5, 6
- Patients should be advised to take Flexeril as directed, usually 5-10 mg three times a day, and to report any side effects such as somnolence or dry mouth 3
- Ibuprofen should be taken as directed, usually 400-800 mg three times a day, and patients should be advised to report any side effects such as gastrointestinal upset or dizziness 4, 5
- Patients should be advised to avoid excessive fatigue and to perform adequate warm-up before intense exercise to prevent further muscle strain injury 2
- Physical therapy should be initiated to restore flexibility and strength as pain and swelling subside 2
Follow-up Care
- Patients should follow up with their healthcare provider within 7-10 days to assess the effectiveness of treatment and to report any side effects or concerns 4, 5
- Patients who do not experience significant improvement in symptoms within 7-10 days should be re-evaluated by their healthcare provider to determine the need for further treatment or referral to a specialist 2
Potential Interactions and Side Effects
- Patients should be advised to report any potential interactions with other medications, such as sedatives or antidepressants, and to avoid taking Flexeril with other CNS depressants 3, 6
- Patients should be advised to report any side effects, such as somnolence, dry mouth, or gastrointestinal upset, and to seek medical attention if they experience any severe or persistent side effects 3, 4, 5, 6