Muscle Relaxants

Background

The skeletal muscle relaxants are a diverse set of drugs used for treating muscle spasms involved in back or neck pain, headaches or fibromyalgia. They are also used to relieve the muscle spasticity, or stiff, rigid muscles with exaggerated reflexes, that can stem from cerebral palsy, multiple sclerosis, or stroke. These medicines should be used with caution because most of them cause sedation as a side effect, which increases the risk of car crashes, falls, and other accidents, and some of them pose a risk of serious problems, such as liver toxicity and addiction.

To help you and your doctor choose the right muscle relaxant, if you need one, Consumer Reports has evaluated the drugs in this category based on their effectiveness, safety, and cost. This brief is a summary of a 19-page report you can access on the Internet at CRBestBuyDrugs.org. You can also learn about other drugs we’ve analyzed on this free Web site. Our independent evaluations are based on scientific reviews conducted by the Oregon Health and Science University-based Drug Effectiveness Review Project. Grants from the Engelberg Foundation and the National Library of Medicine help fund Consumer Reports Best Buy Drugs. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Do You Need a Muscle Relaxant?

If you have a common muscle spasm condition, such as back or neck aches, headaches, or fibromyalgia, you may first want to try to get relief using non-drug therapies, such as heating pads, massage, and yoga. If those don’t work, common over-the-counter pain relievers work as well as muscle relaxants. These include acetaminophen (Tylenol and generic), aspirin, ibuprofen (Advil and generic), and naproxen (Aleve or generic). But if those don’t bring you relief, or you can’t take them for health reasons, you could consider a muscle relaxant.

Where muscle relaxants could be a good first option is the treatment of muscle spasticity associated with disorders such as cerebral palsy, multiple sclerosis, or stroke. Due to the seriousness of these conditions, the benefits of the drugs may be worth the potential risks and consequently, the medicines are considered first-line therapy for spasticity triggered by these disorders.

Our Recommendations

Muscle spasms

If you and your doctor have decided to try a muscle relaxant to treat muscle spasms, taking all of the evidence into consideration, we chose generic cyclobenzaprine tablets as our Best Buy selection. Cyclobenzaprine is supported by the strongest body of evidence among the six muscle relaxants FDA approved for treating muscle spasms (see the chart below). Also, it is available in a generic form that costs $8 to $15 for a seven-day course, which makes it one of the least expensive generic muscle relaxants and significantly less costly than brand-name ones that can run more than $100.

We recommend avoiding carisoprodol (Soma) because it is associated with a high risk of abuse and addiction potential not seen with other muscle relaxants.

Muscle spasticity

Three of the nine available muscle relaxants are FDA approved for treating spasticity.

Taking into consideration all of the evidence on muscle relaxants for spasticity, our Best Buy pick is generic baclofen tablets. Baclofen costs between $27 and $60 for a 30-day supply, so you could save a significant amount of money over some of the more expensive brand-name muscle relaxants, which can cost from $200 to up to $486 a month. In addition to sedation, the most common side effects associated with muscle relaxants include weakness or fatigue, dizziness, and dry mouth.

This information was released in December 2009.

Evidence of Effectiveness

Drug

Spasticity: Evidence showing benefit vs. placebo

Spasms: Evidence showing benefit vs. placebo

Baclofen

+++

Not shown to be beneficial

Dantrolene

+++

Not shown to be beneficial

Tizanidine

++

++

Carisoprodol

Not shown to be beneficial

+

Chlorzoxazone

Not shown to be beneficial

+

Cyclobenzaprine

Not shown to be beneficial

+++

Metaxalone

Not shown to be beneficial

+/-

Methocarbamol

Not shown to be beneficial

+

Orphenadrine

Not shown to be beneficial

+

*Key to chart: +++ = more than 10 randomized trials showing benefit; ++ = 5-9 randomized trials showing benefit; + = 2-4 randomized trials showing benefit; +/- = inconsistent evidence. “Not shown to be beneficial” means the drug is not FDA approved for this indication and there are only 0-2 trials showing benefit.

Cost Comparison

Generic Name and Dose

Brand Name

Typical Dosing Schedule1

Approved Indication1

Average cost per 30 days of use (for spasticity) or per 7 days of use (for muscle spasms)2

Baclofen 10 mg tablet

Generic

Three times daily

Spasticity

$27

Baclofen 20 mg tablet

Generic

Three times daily

Spasticity

$60

Carisoprodol 250 mg tablet

Soma

Three times daily

Spasms

$84

Carisoprodol 350 mg tablet

Soma

Three times daily

Spasms

$147

Carisoprodol 350 mg tablet

Generic

Three times daily

Spasms

$11

Chlorzoxazone 500 mg tablet

Parafon Forte DSC

Three to four times daily

Spasms

$63-$84

Chlorzoxazone 500 mg tablet

Generic

Three to four times daily

Spasms

$8-$11

Cyclobenzaprine 5 mg tablet

Flexeril

Three times daily

Spasms

$42

Cyclobenzaprine 10 mg tablet

Flexeril

Three times daily

Spasms

$42

Cyclobenzaprine 7.5 mg

Fexmid

Three times daily

Spasms

$105

Cyclobenzaprine 5 mg

Generic

Three times daily

Spasms

$15

Cyclobenzaprine 10 mg

Generic

Three times daily

Spasms

$8

Cyclobenzaprine 15 mg continuous-delivery capsule

Amrix

Once daily

Spasms

$91

Cyclobenzaprine 30 mg continuous-delivery capsule

Amrix

Once daily

Spasms

$91

Dantrolene 25 mg capsule

Dantrium

Three to four times daily

Spasticity

$138-$184

Dantrolene 50 mg capsule

Dantrium

Three to four times daily

Spasticity

$165-$220

Dantrolene 100 mg capsule

Dantrium

Three to four times daily

Spasticity

$231-$308

Dantrolene 25 mg capsule

Generic

Three to four times daily

Spasticity

$111-$148

Dantrolene 50 mg capsule

Generic

Three to four times daily

Spasticity

$153-$204

Dantrolene 100 mg capsule

Generic

Three to four times daily

Spasticity

$198-$264

Metaxalone 400 mg tablet

Skelaxin

Three times daily

Spasms

$42

Metaxalone 800 mg tablet

Skelaxin

Three times daily

Spasms

$105

Methocarbamol 500 mg tablet

Robaxin

Four times daily

Spasms

$56

Methocarbamol 750 mg tablet

Robaxin-750

Four times daily

Spasms

$56

Methocarbamol 500 mg tablet

Generic

Four times daily

Spasms

$11

Methocarbamol 750 mg tablet

Generic

Four times daily

Spasms

$14

Orphenadrine 100 mg tablet

Norflex

Twice daily

Spasms

$42

Orphenadrine 100 mg tablet

Generic

Twice daily

Spasms

$28

Tizanidine 2 mg tablet

Zanaflex

Three times daily

Spasticity

$195

Tizanidine 4 mg tablet

Zanaflex

Three times daily

Spasticity

$249

Tizanidine 2 mg capsule

Zanaflex

Three times daily

Spasticity

$249

Tizanidine 4 mg capsule

Zanaflex

Three times daily

Spasticity

$324

Tizanidine 6 mg capsule

Zanaflex

Three times daily

Spasticity

$486

Tizanidine 2 mg tablet

Generic

Three times daily

Spasticity

$81

Tizanidine 4 mg tablet

Generic

Three times daily

Spasticity

$72

Carisoprodol/aspirin 200/ 325 mg tablet

Carisoprodol CPD

Three times daily

Spasms

$42

Carisoprodol/aspirin/codeine 200/325/16 mg tablet

Carisoprodol CPD with codeine

Three times daily

Spasms

$42

Methocarbamol/aspirin 400/325 mg tablet

Generic

Three times daily

Spasms

$13

Orphenadrine/aspirin/caffeine 50/770/60 mg tablet

Norgesic forte

Three times daily

Spasms

$63

Orphenadrine/aspirin/caffeine 25/385/30 mg tablet

Orphenadrine compound

Three times daily

Spasms

$42

Orphenadrine/aspirin/caffeine 50/770/60 mg tablet

Orphenadrine compound

Three times daily

Spasms

$63-$84

Orphenadrine/aspirin/caffeine 25/385/30 mg tablet

Orphengesic

Three times daily

Spasms

$21

1. As typically prescribed. The dose ranges and the drug’s FDA approved indication are derived from drug-labeling information.

2. Prices reflect the nationwide retail average for August 2009, rounded to the nearest dollar. Information is derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health-care professional. Consumers Union is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, non-commercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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