cyclobenzaprine hydrochloride
(sye kloe ben' za preen)
Apo-Cyclobenzaprine (CAN), Flexeril, Novo-Cycloprine (CAN)
Pregnancy Category B
Drug class
Skeletal muscle relaxant (centrally acting)
Therapeutic actions
Precise mechanism not known; does not directly relax tense skeletal muscles but appears to act mainly at brain stem levels or in the spinal cord.
Indications
· Relief of discomfort associated with acute, painful musculoskeletal conditions, as adjunct to rest, physical therapy
· Unlabeled use: Adjunct in the management of fibrositis syndrome
Contraindications and cautions
· Contraindicated with hypersensitivity to cyclobenzaprine, acute recovery phase of MI, arrhythmias, heart block or conduction disturbances, CHF, hyperthyroidism.
· Use cautiously with urinary retention, angle-closure glaucoma, increased IOP, lactation, mild hepatic impairment.
Available forms
Tablets—5, 10 mg
Dosages
ADULTS
5 mg PO tid, 10 mg PO tid (range 20–40 mg/day in divided doses); do not exceed 60 mg/day; do not use longer than 2 or 3 wk.
PEDIATRIC PATIENTS
Safety and efficacy in children < 15 yr not established.
Pharmacokinetics
Route | Onset | Peak | Duration |
Oral | 1 hr | 4–6 hr | 12–24 hr |
Metabolism: Hepatic; T1/2: 1–3 days, 18 hr (range 8–37 hr)
Distribution: Crosses placenta; may enter breast milk
Excretion: Urine
Adverse effects
· CNS: Drowsiness, dizziness, fatigue, tiredness, asthenia, blurred vision, headache, nervousness, confusion
· CV: Arrhythmias, MI
· GI: Dry mouth, nausea, constipation, dyspepsia, unpleasant taste, liver toxicity
· GU: Frequency, urinary retention
Interactions
Drug-drug
· Additive CNS effects with alcohol, barbiturates, other CNS depressants, MAOIs, TCAs; avoid concomitant use
Nursing considerations
Assessment
· History: Hypersensitivity to cyclobenzaprine, acute recovery phase of MI, arrhythmias, CHF, hyperthyroidism, urinary retention, angle-closure glaucoma, increased IOP, lactation
· Physical: Orientation, affect, ophthalmic examination (tonometry); bowel sounds, normal GI output; prostate palpation, normal voiding pattern; thyroid function tests
Interventions
· Arrange for analgesics if headache occurs.
Teaching points
· Take this drug exactly as prescribed. Do not take a higher dosage.
· Avoid alcohol, sleep-inducing, or over-the-counter drugs; these may cause dangerous effects.
· You may experience these side effects: Drowsiness, dizziness, blurred vision (avoid driving or engaging in activities that require alertness); dyspepsia (take drug with food; eat frequent small meals); dry mouth (suck sugarless lozenges or ice chips).
· Report urinary retention or difficulty voiding, pale stools, yellow skin or eyes.
Adverse effects in Italic are most common; those in Bold are life-threatening.
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