Flexeril: Targeted Muscle Spasm Relief for Enhanced Mobility
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Flexeril (cyclobenzaprine HCl) is a centrally acting skeletal muscle relaxant indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions. It works through central nervous system action to reduce tonic somatic motor activity, influencing both gamma and alpha motor systems. By alleviating local muscle hypertonicity without disrupting muscle function, Flexeril helps break the pain-spasm-pain cycle, facilitating earlier mobilization and rehabilitation in appropriate patients. Clinical efficacy has been demonstrated in controlled studies showing superiority to placebo in relieving muscle spasm and associated local pain and tenderness.
Features
- Contains cyclobenzaprine hydrochloride as the active pharmaceutical ingredient
- Available in 5 mg and 7.5 mg oral tablets
- Rapid onset of action, typically within one hour of administration
- Short-term treatment course (usually 2-3 weeks) for acute musculoskeletal conditions
- Bioavailability of approximately 55% with extensive first-pass metabolism
- Mean elimination half-life of 18 hours (range 8-37 hours) with considerable individual variation
- Primarily metabolized via CYP3A4 and CYP1A2 isoenzymes
Benefits
- Effectively reduces painful muscle spasms to restore functional mobility
- Breaks the self-perpetuating cycle of pain leading to spasm leading to more pain
- Allows patients to participate more effectively in physical therapy programs
- Provides adjunctive relief alongside rest and other conservative measures
- Demonstrated superiority over placebo in multiple clinical trials
- Short treatment duration minimizes long-term medication exposure
Common use
Flexeril is primarily indicated as an adjunct to rest and physical therapy for the relief of muscle spasm associated with acute, painful musculoskeletal conditions. It is most commonly prescribed for acute back pain with muscle spasm, whiplash injuries, muscle strains, and other traumatic musculoskeletal injuries where muscle hypertonicity contributes to pain and functional limitation. The medication is specifically intended for short-term use (usually 2-3 weeks) due to insufficient evidence of effectiveness for longer periods and because muscle spasm associated with acute musculoskeletal conditions is generally transient.
Dosage and direction
The recommended dosage of Flexeril for most adults is 5 mg three times daily. Based on individual patient response, the dose may be increased to 7.5 mg or 10 mg three times daily. The maximum recommended dose is 30 mg daily (10 mg three times daily) for no longer than two or three weeks. Tablets should be swallowed whole with water and may be taken with or without food. For elderly patients and those with hepatic impairment, a lower starting dose of 5 mg is recommended with careful titration. The medication should be used at the lowest effective dose for the shortest duration necessary.
Precautions
Flexeril may impair mental and/or physical abilities required for performance of hazardous tasks, such as operating machinery or driving a motor vehicle. Patients should be cautioned about combined effects with alcohol and other CNS depressants. Use with caution in patients with mild hepatic impairment; not recommended in patients with moderate to severe hepatic impairment. May enhance the effects of alcohol, barbiturates, and other CNS depressants. Cyclobenzaprine is closely related to tricyclic antidepressants and may share their risks, including caution in patients with a history of urinary retention, angle-closure glaucoma, increased intraocular pressure, and cardiac arrhythmias. Abrupt discontinuation after prolonged use may produce nausea, headache, and malaise.
Contraindications
Flexeril is contraindicated in patients with hypersensitivity to cyclobenzaprine HCl or any excipients in the formulation. Concurrent use of monoamine oxidase (MAO) inhibitors or within 14 days after their discontinuation. Hyperpyretic crisis, severe convulsions, and deaths have occurred in patients receiving cyclobenzaprine (or structurally similar tricyclic antidepressants) concomitantly with MAO inhibitor drugs. Contraindicated during the acute recovery phase of myocardial infarction, and in patients with arrhythmias, heart block or conduction disturbances, congestive heart failure, or hyperthyroidism.
Possible side effects
The most common adverse reactions (occurring at approximately 3% or greater) include drowsiness (29-39%), dry mouth (21-28%), dizziness (6-11%), and fatigue (6%). Less frequent side effects (1-3%) include nausea, dyspepsia, unpleasant taste, blurred vision, headache, nervousness, and confusion. Rare but serious adverse effects may include tachycardia, arrhythmias, syncope, seizures, hepatitis, and allergic reactions including anaphylaxis. Elderly patients may be more susceptible to side effects, particularly CNS effects, and may experience hallucinations. Patients should report any persistent or severe side effects to their healthcare provider.
Drug interaction
Flexeril has significant interaction potential, particularly with: MAO inhibitors (contraindicated due to risk of serotonin syndrome and hypertensive crisis); other CNS depressants including alcohol, benzodiazepines, opioids, and sedative-hypnotics (additive CNS depression); anticholinergic agents (increased anticholinergic effects); tramadol (increased seizure risk); and drugs metabolized by CYP3A4 and CYP1A2 (potential for altered concentrations of either drug). Concurrent use with anticholinergics may lead to paralytic ileus. Use with guanethidine or similar agents may block its antihypertensive effect.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. Consistent dosing is important for maintaining therapeutic effect, but occasional missed doses are unlikely to significantly impact overall treatment efficacy given the medication’s half-life. Patients should contact their healthcare provider if multiple doses are missed or if they have questions about dosing.
Overdose
Flexeril overdose may be life-threatening and manifests primarily as CNS depression (ranging from drowsiness to coma), anticholinergic effects (tachycardia, dry mouth, blurred vision, urinary retention), and cardiovascular effects (hypotension or hypertension, cardiac arrhythmias, conduction disturbances). Severe overdose may result in cardiac arrest, shock, congestive heart failure, and seizures. Treatment is symptomatic and supportive, with attention to maintaining adequate airway and vital signs. Gastric lavage may be beneficial if performed soon after ingestion. Activated charcoal may be administered. Cardiac monitoring is recommended for at least 24 hours. There is no specific antidote.
Storage
Store Flexeril tablets at controlled room temperature 20°-25°C (68°-77°F) with excursions permitted to 15°-30°C (59°-86°F). Keep in the original container, tightly closed, and protect from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Properly discard any unused medication after the treatment course is completed, preferably through a medicine take-back program or by mixing with an undesirable substance (such as coffee grounds or kitty litter) in a sealed container before disposing in household trash.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Flexeril is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual response to medication may vary, and only your healthcare provider can determine if this medication is appropriate for your specific condition. Never adjust your dosage or discontinue medication without consulting your prescriber. Report any adverse effects to your healthcare provider promptly. This information is not exhaustive; please refer to the full prescribing information for complete details.
Reviews
Clinical studies demonstrate Flexeril’s efficacy in muscle spasm relief. In double-blind trials involving over 1400 patients, Flexeril 10 mg three times daily provided significantly greater relief of muscle spasm than placebo (p<0.05) and was comparable to other muscle relaxants. Patients reported improved global assessment and reduced local pain and tenderness. Most therapeutic effect occurs within the first week of treatment. In practice, many clinicians report good results with the 5 mg dose, particularly in elderly patients or those sensitive to side effects. Patient satisfaction is generally high when used appropriately for acute conditions, though some report sedation as a limiting factor.