The authors also described several limitations of the meta-analysis including inadequate blinding, heterogeneity among studies, and the presence of publication bias.

Skeletal muscle relaxants have also been studied as adjunctive therapy to analgesics in treating acute low back pain. In one open-label study 20 patients , the addition of cyclobenzaprine to naproxen Naprosyn resulted in a statistically significant decrease in muscle spasm and tenderness compared with naproxen alone.

Cyclobenzaprine has also been studied in treating fibromyalgia. A meta-analysis of five trials ranging from six to 24 weeks' duration included a total of patients with fibromyalgia.

The authors reported that, although cyclobenzaprine moderately improved sleep and pain, the long-term benefits were unknown. This meta-analysis was limited by a high drop-out rate, short trial duration, few studies having an intention-to-treat design, and inadequate blinding. Strong data comparing skeletal muscle relaxants to each other are scarce. A systematic review evaluated 46 trials head-to-head and placebo-controlled comprising mostly of studies on low back pain or neck syndromes.

The placebo-controlled trials included 17 on cyclobenzaprine, six on tizanidine, four on carisoprodol, and four on orphenadrine, and were mostly conducted more than 15 years ago. The average patient enrollment was less than patients range 12 to patients.

In general, all of the drugs were shown to have some benefit. One fair-quality study showed carisoprodol was better than diazepam at improving muscle spasm and global and functional status in patients with low back pain.

A different systematic review did include some studies which were considered to be high quality. Although the evidence for effectiveness of skeletal muscle relaxants in musculoskeletal conditions is limited, strong evidence does exist in terms of toxicity. Selection of a skeletal muscle relaxant should be individualized to the patient.

If there are tender spots over the muscle or trigger points on physical examination, a skeletal muscle relaxant is a reasonable adjunct to analgesic treatment of low back pain. Skeletal muscle relaxants may also be used as an alternative to NSAIDs in patients who are at risk of gastrointestinal or renal complications.

Patients with low back pain or fibromyalgia may benefit from treatment with cyclobenzaprine. Recent evidence showed similar effectiveness at half of its manufacturer recommended dose 5 mg , but with fewer adverse effects.

Higher doses of cyclobenzaprine or tizanidine would be appropriate to promote sedation in cases of more severe discomfort or perceived muscular spasm. Although there appears to be insufficient data on metaxalone and methocarbamol, these may be useful in patients who cannot tolerate the sedative properties of cyclobenzaprine or tizanidine. Of note, methocarbamol costs substantially less than metaxalone.

Carisoprodol is metabolized to meprobamate a class III controlled substance and has been shown to produce psychological and physical dependence. Although all skeletal muscle relaxants should be used with caution in older patients, diazepam especially should be avoided in older patients or in patients with significant cognitive or hepatic impairment.

Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. She received her doctor of pharmacy degree from Rutgers University College of Pharmacy in New Brunswick, NJ, and completed an inpatient family medicine pharmacy specialty residency at Deaconess Hospital and the St.

Louis College of Pharmacy in St. Louis, Mo. She received her doctor of pharmacy degree from St. Reprints are not available from the authors. Carisoprodol carisoprodol tablet [package insert]. Philadelphia, Pa.

Accessed January 14, Chlorzoxazone chlorzoxazone tablet [package insert]. Sellersville, Pa. Cyclobenzaprine hydrochloride cyclobenzaprine hydrochloride tablet [package insert]. Corona, Calif. Diazepam diazepam tablet [package insert]. Miami, Fla. Skelaxin metaxalone [package insert]. Briston, Tenn. Methocarbamol methocarbamol tablet [package insert]. January 14, Orphenadrine citrate extended-release orphenadrine citrate tablet [package insert].

Princeton, NJ: Sandoz, Inc. Tizanidine hydrochloride tizanidine hydrochloride tablet [package insert]. Pomona, NY: Barr Laboratories. United States Food and Drug Administration. Zanaflex tizanidine hydrochloride tablets and capsules.

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Arthritis Rheum. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. Prescription of nonsteroidal anti-inflammatory drugs and muscle relaxants for back pain in the United States.

Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: a systematic review. J Pain Symptom Manage. Diamond S. Double-blind study of metaxalone; use as a skeletal-muscle relaxant.

Chou R, Huffman LH. Activity of tetrazepam in low back pain. Clin Trials J. Treatment of chronic low-back syndrome with tetrazepam in a placebo controlled double-blind trial. J Drug Dev. Scheiner JJ. Cyclobenzaprine in the treatment of local muscle spasm.

Minneapolis, Minn. Aiken DW. A comparative study of the effects of cyclobenzaprine, diazepam, and placebo on acute skeletal muscle spasm of local origin. Brown BR jr, Womble J.

Cyclobenzaprine in intractable pain syndrome with muscle spasms. Basmajian JV. Cyclobenzaprine hydrochloride effect on skeletal muscle spasm in the lumbar region and neck: two double-blind controlled clinical laboratory studies.

Arch Phys Med Rehabil. Cyclobenzaprine and back pain: a meta-analysis. Arch Intern Med. Cyclobenzaprine and naproxen versus naproxen alone in the treatment of acute low back pain and muscle spasm.

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Bragstad A, Blikra G. Evaluation of a new skeletal muscle relaxant in the treatment of lower back pain a comparison of DS — with chlorzoxazone. Curr Ther Res Clin Exp. A clinical and pharmacologic review of skeletal muscle relaxants for musculoskeletal conditions. Am J Ther. Borenstein DG, Korn S. Efficacy of a low-dose regimen of cyclobenzaprine hydrochloride in acute skeletal muscle spasm: results of two placebo-controlled trials.

Carisoprodol: a marginally effective skeletal muscle relaxant with serious abuse potential. Hosp Pharm. Skelaxin and Flexeril are both indicated to be used along with rest, physical therapy, and other measures to relieve the discomfort of acute, painful musculoskeletal conditions like acute low back pain or neck pain.

Both drugs may be prescribed off-label for other conditions, but they are primarily used for muscle spasms. Also, the Flexeril manufacturer information states that the drug is not effective for spasticity associated with cerebral or spinal cord disease, or in children with cerebral palsy. American Family Physician states that there is weak and very little evidence in terms of muscle relaxants and their efficacy compared to each other. They recommend that the selection of a muscle relaxant should be based on the potential for side effects, drug interactions, abuse, and also patient preference.

This publication also reiterates the importance of short-term use of muscle relaxants and that physical therapy and other measures should be taken to prevent long-term use of a muscle relaxant.

Other medications such as Tylenol acetaminophen or nonsteroidal anti-inflammatory drugs NSAIDs , such as ibuprofen, may also be used.

Your healthcare provider can determine if Skelaxin or Flexeril is appropriate for you. He or she will consider your symptoms, medical conditions, medical history, and any medications you take that may interact with Skelaxin or Flexeril.

Most insurance plans typically cover Skelaxin in its generic form of metaxalone. Medicare Part D coverage varies. Most insurance and Medicare Part D plans cover Flexeril generic. Brand-name Flexeril is not available.

Both drugs can be very sedating. With either drug, an allergic reaction is rare but possible. Serotonin syndrome , a life-threatening condition due to serotonin buildup, is also possible. Skelaxin and Flexeril can potentiate the effects of alcohol, barbiturates, and other CNS depressants, such as benzodiazepines, opioids, antihistamines, and sedative-hypnotics.

There is an increased risk of serotonin syndrome when Skelaxin or Flexeril is taken with other drugs that increase serotonin; such as SSRI, SNRI, or tricyclic antidepressants; triptans for migraine; or cough and cold medications that contain dextromethorphan.

Flexeril is structurally similar to tricyclic antidepressants such as amitriptyline and nortriptyline. Because of this, there is an increased risk of seizures when taken with tramadol. Both Skelaxin and Flexeril interact with tramadol and other opioids —there is an increased risk of serotonin syndrome as well as additive CNS depression. This is not a full list of drug interactions. Consult your healthcare provider for medical advice regarding drug interactions.

Skelaxin is a skeletal muscle relaxant used for the acute treatment of muscle spasms. The generic name for Skelaxin is metaxalone. Flexeril is also a muscle relaxant used to treat skeletal muscle spasms. The generic name of Flexeril is cyclobenzaprine. Although Skelaxin and Flexeril are both in the same drug category skeletal muscle relaxants , they do have some differences, such as side effects, dose, and pricing, as outlined above. No data directly compares the two drugs in terms of pain relief.

Therefore, if you need a muscle relaxant, your healthcare provider will consider your symptoms, conditions, and any medications you take that could interact with Skelaxin or Flexeril to determine if one of these drugs is better for you. Safe use of metaxalone has not been established with regard to possible adverse effects upon fetal development. The Flexeril manufacturer information states that there are no adequate, well-controlled studies in pregnant women.

Therefore, Flexeril should be used in pregnant women only if clearly needed. Using Skelaxin or Flexeril with alcohol can increase the side effects such as dizziness and drowsiness. It can also lead to impaired coordination, which can cause accidents. Also, taking a muscle relaxant with alcohol can increase the chance of abuse or dependence. Consult your healthcare provider for more information.