Flexeril: Targeted Muscle Spasm Relief for Enhanced Mobility
Flexeril
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Flexeril (cyclobenzaprine hydrochloride) is a centrally acting skeletal muscle relaxant indicated as an adjunct to rest and physical therapy for the relief of muscle spasm associated with acute, painful musculoskeletal conditions. It works by acting primarily within the central nervous system at the brainstem level, reducing tonic somatic motor activity without directly affecting skeletal muscle fibers or the neuromuscular junction. This mechanism provides effective relief from acute muscle spasms, helping to alleviate pain and restore functional mobility. Clinical efficacy is typically observed within the first few days of therapy, making it a valuable short-term option in comprehensive pain management protocols.
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
- FDA-approved for acute musculoskeletal conditions
- Short-term therapy formulation (typically 2-3 weeks)
- Central nervous system-mediated mechanism of action
- Bioavailability of approximately 55% following oral administration
- Extensive hepatic metabolism via cytochrome P450 system
Benefits
- Effectively reduces painful muscle spasms that limit mobility
- Facilitates participation in physical therapy and rehabilitation programs
- Helps break the pain-spasm-pain cycle common in acute musculoskeletal injuries
- Provides adjunctive relief alongside rest and other conservative measures
- Improves range of motion and functional capacity during recovery
- Short-term therapy minimizes risk of dependency and tolerance development
Common use
Flexeril is primarily prescribed for the short-term management of muscle spasm associated with acute, painful musculoskeletal conditions. This includes but is not limited to acute muscle strains, sprains, and other traumatic injuries affecting the musculoskeletal system. It is commonly utilized in cases of acute lower back pain with associated muscle spasm, whiplash injuries, and post-surgical muscle spasm. The medication is typically employed as part of a comprehensive treatment approach that includes rest, physical therapy, and other pain management strategies. Clinical studies demonstrate its effectiveness particularly in the first 7-14 days of acute musculoskeletal conditions.
Dosage and direction
The recommended dosage of Flexeril for most adults is 5 mg three times daily. Depending on individual response and tolerability, the dosage may be increased to 7.5 mg or 10 mg three times daily. Tablets should be swallowed whole with a full glass of water and may be taken with or without food. The maximum recommended daily dose is 30 mg (divided into three doses). Therapy should be limited to two or three weeks, as sufficient data regarding efficacy and safety beyond this period are not available. Dosage adjustment is recommended for elderly patients and those with hepatic impairment, typically starting with 5 mg and monitoring closely for adverse effects.
Precautions
Patients should be cautioned about engaging in activities requiring mental alertness, such as operating machinery or driving, as Flexeril may cause drowsiness. Concurrent use with alcohol or other CNS depressants should be avoided due to additive sedative effects. Use with caution in patients with mild to moderate hepatic impairment, and generally avoided in severe hepatic impairment. Elderly patients may be more sensitive to the effects of cyclobenzaprine and typically require lower dosing. Patients should be monitored for signs of serotonin syndrome, particularly when used concomitantly with other serotonergic drugs. Abrupt discontinuation after prolonged use should be avoided.
Contraindications
Flexeril is contraindicated in patients with hypersensitivity to cyclobenzaprine hydrochloride or any component of the formulation. Concurrent use with monoamine oxidase inhibitors (MAOIs) or within 14 days of their discontinuation is contraindicated due to risk of hypertensive crisis and serotonin syndrome. It is contraindicated in patients with hyperthyroidism, recent myocardial infarction, cardiac arrhythmias including heart block, conduction disturbances, or congestive heart failure. The medication is contraindicated in patients with severely impaired hepatic function.
Possible side effect
Common adverse reactions (occurring in >3% of patients) include drowsiness (29-39%), dry mouth (21-32%), dizziness (6-11%), and fatigue (6%). Less frequent side effects may include headache, nervousness, confusion, nausea, constipation, dyspepsia, unpleasant taste, and blurred vision. Rare but serious adverse effects may include tachycardia, arrhythmias, syncope, seizures, hepatitis, and allergic reactions including anaphylaxis. Serotonin syndrome may occur particularly when used with other serotonergic agents. Patients should be advised to report any persistent or severe side effects to their healthcare provider.
Drug interaction
Flexeril has significant interactions with MAO inhibitors, potentially leading to hypertensive crisis or serotonin syndrome. Concomitant use with other CNS depressants (alcohol, benzodiazepines, opioids, sedative antihistamines) may result in additive CNS depression. Strong inhibitors of CYP3A4 (ketoconazole, clarithromycin) may increase cyclobenzaprine concentrations. Use with tramadol may increase seizure risk. Concurrent use with other anticholinergic drugs may result in additive anticholinergic effects. Serotonergic drugs (SSRIs, SNRIs, triptans) may increase risk of serotonin syndrome. Guanethidine and similar antihypertensives may have their effects antagonized.
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, the missed dose should be skipped and the regular dosing schedule resumed. Patients should 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 relatively short half-life (approximately 18 hours) and steady-state achievement within 3-4 days.
Overdose
Overdose may manifest as severe drowsiness, tachycardia, tremor, agitation, confusion, hallucinations, and cardiac arrhythmias. Severe overdose may lead to coma, cardiac arrest, and death. Management involves supportive care with monitoring of cardiac function and vital signs. Gastric lavage may be considered if presentation is early. Activated charcoal may be administered. There is no specific antidote for cyclobenzaprine overdose. Treatment should focus on symptomatic management, including control of arrhythmias and supportive respiratory care. Dialysis is unlikely to be beneficial due to high protein binding and extensive tissue distribution.
Storage
Store Flexeril tablets at controlled room temperature between 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C to 30°C (59°F to 86°F). Keep in the original container with the lid tightly closed to protect from moisture and light. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Properly dispose of any unused medication through medication take-back programs or according to FDA-recommended disposal guidelines to prevent accidental ingestion or environmental contamination.
Disclaimer
This information is provided 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 a healthcare provider can determine the appropriate treatment based on specific medical conditions, concurrent medications, and individual health status. Patients should not initiate, discontinue, or change dosage without consulting their healthcare provider. This information is not exhaustive and does not replace the full prescribing information provided by the manufacturer.
Reviews
Clinical studies demonstrate that Flexeril provides significant relief from acute muscle spasm compared to placebo, with most patients experiencing improvement within the first few days of treatment. In randomized controlled trials, approximately 70-80% of patients treated with cyclobenzaprine reported moderate to excellent relief of muscle spasm symptoms. Many patients report improved ability to participate in physical therapy and daily activities. Some users note drowsiness as a limiting factor, particularly during the initial days of treatment. Healthcare providers generally consider it an effective short-term option for acute musculoskeletal conditions when used as part of a comprehensive treatment plan. Long-term efficacy data beyond three weeks remains limited.