From the FDA Drug Label
DOSAGE AND ADMINISTRATION Methocarbamol, 750 mg — Adults: Initial dosage: 2 tablets q.i.d. Maintenance dosage: 1 tablet q.4h. or 2 tablets t.i.d. Six grams a day are recommended for the first 48 to 72 hours of treatment. (For severe conditions 8 grams a day may be administered). Thereafter, the dosage can usually be reduced to approximately 4 grams a day.
The recommended dosage for methocarbamol 750 mg is 2 tablets q.i.d. or 1 tablet q.4h. or 2 tablets t.i.d. for maintenance.
- 750 mg BID is not a recommended dosage regimen in the label.
- The maximum recommended dosage is 8 grams a day for severe conditions for the first 48 to 72 hours and 6 grams a day for the first 48 to 72 hours for other conditions, and 4 grams a day thereafter.
- Prescribing 750 mg BID for six months would be 1500 mg a day, which is below the maximum recommended dosage, but the specific regimen is not mentioned in the label 1. The FDA drug label does not answer the question.
From the Research
No, I would not recommend prescribing methocarbamol 750 mg BID for six months due to potential side effects and concerns about effectiveness over prolonged periods. Methocarbamol is a muscle relaxant typically prescribed for short-term relief of muscle spasms and pain. The most recent and highest quality study, 2, found that muscle relaxants, including methocarbamol, do not improve outcomes more than placebo in patients with acute low back pain. Additionally, the study found that methocarbamol had a lower mean improvement in the Roland-Morris Disability Questionnaire (RMDQ) compared to other muscle relaxants. Other studies, such as 3, have also shown that muscle relaxants may increase the risk of adverse events and have little to no effect on acceptability. Most treatment guidelines suggest using muscle relaxants like methocarbamol for acute conditions, usually for 2-3 weeks. Long-term use may lead to tolerance, dependence, and side effects including drowsiness, dizziness, and headache. Some key points to consider when prescribing muscle relaxants include:
- The underlying cause of muscle pain should be addressed rather than just treating symptoms long-term
- Alternative treatments such as physical therapy or other pain management strategies should be considered
- The risk of adverse events and the potential for little to no effect on acceptability should be taken into account
- The most recent and highest quality evidence should be used to guide treatment decisions, such as the study by 2.