From the Guidelines
The maximum daily dose of tizanidine is 36 mg, divided into three equal doses of 8 mg every 8 hours. According to the provided evidence [ 1 ], tizanidine dosing starts with 2 mg orally at night and, if well tolerated, can be increased by 2-4 mg every day up to 8 mg every 8 hours. Key considerations for tizanidine use include:
- Contraindications such as concomitant use with methadone due to increased risk of prolonged QTc, and use with CYP1A2 inhibitors
- Adverse effects like sedation, hypotension, dry mouth, asthenia, dizziness, somnolence, and hepatotoxicity
- The need for dose reduction and monitoring in patients with hepatic and renal impairment
- Pregnancy class C and potential infant risk during breastfeeding. It is essential to monitor liver function during treatment, especially with higher doses, as tizanidine is primarily metabolized by the liver [ 1 ]. Patients should be cautious about taking tizanidine with alcohol, CNS depressants, or CYP1A2 inhibitors, as these can significantly increase tizanidine blood levels and side effects.
From the FDA Drug Label
WARNINGS LIMITED DATA BASE FOR CHRONIC USE OF SINGLE DOSES ABOVE 8 MG AND MULTIPLE DOSES ABOVE 24 mg PER DAY Clinical experience with long-term use of tizanidine at doses of 8 to 16 mg single doses or total daily doses of 24 to 36 mg (see DOSAGE AND ADMINISTRATION) is limited
The maximum daily dose of tizanidine is 36 mg, as limited clinical experience is available at this dose. However, it is essential to note that the FDA drug label warns of limited data for chronic use of single doses above 8 mg and multiple doses above 24 mg per day 2.
From the Research
Maximum Daily Dose of Tizanidine
- The maximum daily dose of tizanidine is not explicitly stated in the provided studies 3, 4, 5, 6.
- However, the studies mention the doses used in various cases, such as 2mg of tizanidine 5 and daily doses of 20mg or more of baclofen 6.
- It is essential to note that the dosage of tizanidine may vary depending on the individual patient's condition and response to the medication.
- The studies emphasize the importance of close monitoring and caution when using tizanidine, especially in older adults or those with certain co-morbidities 4, 5, 6.
Adverse Effects and Interactions
- Tizanidine has been associated with adverse effects such as dry mouth, bradycardia, and hypotension 3, 4, 5.
- Concomitant administration of tizanidine with other medications like lisinopril, beta-blockers, or angiotensin-converting enzyme inhibitors may increase the risk of hypotension and bradycardia 4, 5.
- The studies highlight the need for careful consideration and monitoring when prescribing tizanidine, especially in patients with multiple co-morbidities or those taking other medications 4, 5, 6.