From the Research
When considering cyclobenzaprine versus methocarbamol for a person taking clonazepam who has Borderline Personality Disorder (BPD), methocarbamol is generally the safer choice. Cyclobenzaprine should be avoided due to its potential for additive central nervous system depression when combined with clonazepam, which increases risks of sedation, respiratory depression, and cognitive impairment. Methocarbamol (typically 750-1500 mg three to four times daily) has less sedative effect and fewer drug interactions with benzodiazepines like clonazepam. If methocarbamol is prescribed, start at a lower dose (perhaps 750 mg three times daily) and monitor for excessive sedation before increasing. Both medications are muscle relaxants, but they work differently - cyclobenzaprine acts centrally on the brainstem while methocarbamol works through multiple mechanisms including central nervous system depression. For someone with BPD who may be more vulnerable to medication side effects and may have impulse control issues, avoiding medications with higher addiction potential or sedative effects is important, as noted in a comprehensive review of BPD diagnosis, treatment, and controversies 1. Regular follow-up is essential to monitor for side effects and assess effectiveness, considering that psychotherapy is the treatment of choice for BPD, with various approaches having empirical support, but no clear evidence for the efficacy of any psychoactive medication for core BPD features 1. In the context of managing BPD, it's crucial to prioritize treatments that minimize risks and maximize benefits, given the complexity of the disorder and its significant impact on quality of life, as discussed in recent reviews on BPD treatment and pharmacotherapy 2, 1. Given the most recent and highest quality evidence, methocarbamol is the preferred option over cyclobenzaprine for a person with BPD taking clonazepam, due to its safer profile and lower risk of adverse interactions 1.