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Pharmacologic class: Autonomic nervous system drug
Therapeutic class: Skeletal muscle relaxant (centrally acting)
Pregnancy risk category B
Unclear. Thought to act primarily at brain stem (and to a lesser extent at spinal cord level) to relieve skeletal muscle spasms of local origin without altering muscle function.
Capsules (extended-release): 15 mg, 30 mg
Tablets: 5 mg, 7.5 mg, 10 mg
Indications and dosages
➣ Adjunct to rest and physical therapy to relieve muscle spasm associated with acute, painful musculoskeletal conditions
Adults: 5 mg P.O. t.i.d. (immediate-release tablet). May increase to 10 mg P.O. t.i.d. (immediate-release tablet) as needed. Or, 15 mg (extended-release capsule) P.O. daily; some patients may need up to 30 mg/day, given as one 30-mg (extended-release capsule) P.O. daily or two 15-mg (extended-release capsules) P.O. daily.
• Hypersensitivity to drug
• Acute recovery phase after myocardial infarction (MI)
• Heart failure
• MAO inhibitor use within past 14 days
Use cautiously in:
• cardiovascular disease, closed-angle glaucoma, hepatic impairment, increased intraocular pressure, urinary retention
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 15.
☞ Don't give within 14 days of MAO inhibitor. Drug interaction may cause hypertensive crisis and severe seizures.
• Give extended-release capsule at approximately the same time each day.
• Know that drug shouldn't be used for more than 3 weeks.
• Be aware that drug may not be first-line agent for elderly patients because of its anticholinergic effects.
CNS: dizziness, drowsiness, syncope, confusion, fatigue, headache, nervousness, decreased mental acuity, irritability, weakness, insomnia, depression, disorientation, delusions, peripheral neuropathy, abnormal gait, Bell's palsy, EEG changes, extrapyramidal symptoms, cerebrovascular accident
CV: vasodilation, tachycardia, chest pain, hypotension, MI, heart block
EENT: blurred vision
GI: nausea, constipation, dyspepsia, swollen parotid glands, mouth inflammation, discolored tongue, dry mouth, paralytic ileus
GU: galactorrhea, urinary retention, urinary frequency, gynecomastia, testicular swelling, libido changes, erectile dysfunction
Hematologic: purpura, eosinophilia, bone marrow depression, leukopenia, thrombocytopenia
Metabolic: hyperglycemia, hypoglycemia, syndrome of inappropriate diuretic hormone secretion
Musculoskeletal: muscle ache
Skin: photosensitization, alopecia, angioedema
Other: unpleasant taste, weight gain or loss, edema
Drug-drug. Anticholinergics, anti-cholinergic-like drugs (including anti-depressants, antihistamines, disopyramide, haloperidol, phenothiazines): additive anticholinergic effects
Antihistamines, CNS depressants, opioids, sedative-hypnotics: additive CNS depression
Guanadrel, guanethidine: reduction in or blockage of these drugs' actions
MAO inhibitors: hyperpyretic crisis, seizures, death
Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression
Drug-behaviors. Alcohol use: increased CNS depression
• Assess for adverse CNS effects, such as drowsiness, dizziness, and decreased mental acuity.
• Monitor patient for evidence of drug interactions, especially when giving drug with CNS depressants.
• Tell patient to take extended-release capsule at approximately the same time each day.
• Tell patient that drug may cause dry mouth.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, alertness, and vision.
• Advise patient not to use alcohol, sedatives, pain medications, over-the-counter preparations, or herbs without consulting prescriber.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.
Patient discussion about Flexeril
Q. what are the side effects from taking soma and flexerill together? the person who takes it is almost comatos for a couple of hours. What is a substition?