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Sunday, February 6, 2011

cyclobenzaprine hydrochloride

Posted by Sampil 10:06 PM, under | No comments

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
·        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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