Overview
Tizanidine (Zanaflex) is a muscle relaxer used to treat stiff, rigid muscles. It's taken by mouth, typically 3 times a day. Tizanidine (Zanaflex) isn't a controlled substance, so it isn't known to cause an addiction. But it does have several risks and warnings for side effects such as low blood pressure, dry mouth, and sleepiness. Tizanidine (Zanaflex) comes as both brand and generic name tablets and capsules.
What is Tizanidine (Zanaflex) used for?
- Muscle stiffness and rigidity
How Tizanidine (Zanaflex) works
Tizanidine (Zanaflex) is a type of muscle relaxer called an alpha-2 adrenergic receptor agonist. It works by slowing down nerves in your spinal column that control muscle tone. When those nerves slow down, your muscles relax.
When does Tizanidine (Zanaflex) start working?
Time passed since treatment started:
Pharmacist tips for Tizanidine (Zanaflex, Sirdalud)
- You can take tizanidine (Zanaflex) with or without food. But you should try to be consistent each time. This is because food causes your body to absorb the medication differently, which can affect how well this medication works and its side effects.
- If you choose to take tizanidine (Zanaflex) with food, always take it within 30 minutes of a meal. If you choose to take tizanidine (Zanaflex) without food, always wait at least 3 hours after a meal to take your medication.
- If your provider switched you from tizanidine (Zanaflex) tablets to capsules, be aware that you might notice some differences between how fast or how well the tablets and capsules work. If you take tizanidine (Zanaflex) tablets with food, you might feel their effects more quickly. But if you take tizanidine (Zanaflex) capsules, it can take longer before you experience their effects.
- If you're having a hard time swallowing your tizanidine (Zanaflex) capsule, you can open it up and sprinkle the contents on applesauce. You will have to be consistent and always take the medication this way because the amount of tizanidine (Zanaflex) your body absorbs is different if it's sprinkled on applesauce than if you swallow the capsule whole.
- If you have been on tizanidine (Zanaflex) for a long period of time, you shouldn't stop this medication suddenly. This can cause withdrawal symptoms, including high blood pressure, muscle spasticity, and a fast heartbeat. Talk to your provider if you want to stop taking tizanidine (Zanaflex). They will work with you to lower your dose safely.
- Tizanidine (Zanaflex) can cause low blood pressure, especially if you change positions too quickly. This can cause you to get dizzy and fall. Whenever possible, try to stand up from sitting or lying down slowly and place your hands on a sturdy object while getting up.
- Tell your healthcare provider about all the medications you're taking, including over-the-counter products. Tizanidine (Zanaflex) can interact with certain medications, including the antibiotic ciprofloxacin, and lead to very low blood pressure and a slow heartbeat.
- Side effects like dizziness and sleepiness are common. Don't drink alcohol while taking tizanidine (Zanaflex), as it can make these side effects worse.
- Tizanidine (Zanaflex) can affect your ability to focus and concentrate. Avoid driving or performing any activity that requires a lot of attention until you know how this medication affects you.
- A common side effect of tizanidine (Zanaflex) is dry mouth. Chewing gum or sucking on ice can help with this. There are also special mouthwashes and lozenges available at your local pharmacy that can help.
What are the risks and warnings for Tizanidine (Zanaflex)?
Tizanidine (Zanaflex) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Low blood pressure
- Risk factors: Age 65 years or older | Taking blood pressure medications | Taking fluvoxamine or ciprofloxacin | Standing up from lying down quickly
Tizanidine (Zanaflex) can cause low blood pressure and dizziness, especially when you first start the medication and any time your provider raises your dose. Your provider will try to minimize these side effects by raising your dose slowly over time. To lower your risk of falls, make sure you stand up slowly from a lying position and use a sturdy object to help yourself up. If you continue to feel dizzy or unsteady, or if your blood pressure is too low, talk to your provider.
Extreme sleepiness
- Risk factors: Taking with alcohol or illicit drugs | Taking other medications that cause drowsiness | People over 65
Taking tizanidine (Zanaflex) can make you feel sleepy and affect your concentration and focus. This is more likely to happen if you're over 65 or take other medications that cause drowsiness. Don't drink alcohol while taking this medication. Avoid activities that require you to be alert, like driving or operating machinery, until you know how the medication affects you.
Worsening drowsiness (from medication interactions)
There are certain mediations that can interact with tizanidine (Zanaflex) and worsen low blood pressure and dizziness. For examples, you're not recommended to take tizanidine (Zanaflex) along with clonidine (Catapress) or guanfacine. And you need to avoid taking tizanidine (Zanaflex) if you take either fluvoxamine (Luvox) or ciprofloxacin (Cipro).
Make sure to tell both your healthcare provider and your pharmacist about all medications and over-the-counter products you are taking before you start tizanidine (Zanaflex), even if you only take them once in a while or as needed.
Higher risk of tizanidine side effects (in people with kidney problems)
- Risk factors: History of kidney problems
People who have kidney problems should be careful using tizanidine (Zanaflex). Tizanidine (Zanaflex) is processed by the kidneys, and if the kidneys aren't working properly, you could have a buildup of tizanidine (Zanaflex) in your body. This buildup can raise your risk of side effects like drowsiness and dizziness or make them more intense. If you have kidney problems, you will most likely be given lower doses of tizanidine (Zanaflex) to prevent these issues.
Liver damage
- Risk factors: History of liver problems
Tizanidine (Zanaflex) can cause liver injury. If you have liver problems, you might not be able to take this medication. Or, your provider might ask you get blood tests done regularly to check your liver health.
Hallucinations
A very small number of people have experienced hallucinations after starting tizanidine (Zanaflex). For most people, the hallucinations went away once they stopped taking the medication. Talk to your healthcare provider if this happens to you. There might be alternative muscle relaxers that are better options for you.
Withdrawal symptoms
- Risk factors: Taking tizanidine (Zanaflex) for more than 9 weeks | Taking high doses of tizanidine (Zanaflex) | Also taking narcotic pain medications | Stopping tizanidine (Zanaflex) suddenly
If you stop taking tizanidine (Zanaflex) suddenly, you might experience withdrawal symptoms, including high blood pressure, a fast heartbeat, and muscle stiffness. This is more common if you've been taking a total of 20 mg to 36 mg per day for more than 9 weeks and then suddenly stop. It's also more likely to happen if you are taking both tizanidine (Zanaflex) and certain pain medications, such as oxycodone or morphine. Talk to your healthcare provider if you would like to stop taking tizanidine (Zanaflex). They can help you lower your dose safely.
Allergic reactions
Severe allergic reactions to tizanidine (Zanaflex) are possible, including life-threatening problems like anaphylaxis (closing of the throat). Call 911 if this happens. If you notice hives, a rash, swelling of the lips or tongue, or difficulty breathing after using tizanidine (Zanaflex), call your healthcare provider right away.
Strengths
Capsule
- 2mg
- 4mg
- 6mg
Tablet
- 2mg
- 4mg
Dosages
- Adults: The typical starting dose is 2 mg by mouth every 6 to 8 hours, as needed (up to 3 doses a day). If needed, your provider might raise your dose every few days, up to a total of 36 mg per day.
Your dose might be different if you have liver or kidney problems.
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Interactions
Tizanidine (Zanaflex) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Tizanidine (Zanaflex). Please note that only the generic name of each medication is listed below.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Ciprofloxacin
- Fluvoxamine
- Viloxazine
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alfentanil
- Alprazolam
- Benzhydrocodone
- Bromazepam
- Buprenorphine
- Butorphanol
- Calcium Oxybate
- Cannabidiol
- Capmatinib
- Cetirizine
- Cimetidine
- Clozapine
- Codeine
- Deferasirox
- Desogestrel
- Dienogest
- Dihydrocodeine
- Doxylamine
- Drospirenone
- Esketamine
- Estradiol Valerate
- Ethinyl Estradiol
- Ethynodiol Diacetate
- Famotidine
- Fentanyl
- Flibanserin
- Gabapentin
- Gabapentin Enacarbil
- Gestodene
- Givosiran
- Glucagon
- Glycopyrrolate
- Glycopyrronium Tosylate
- Hydrocodone
- Hydromorphone
- Ketamine
- Lemborexant
- Levocetirizine
- Levonorgestrel
- Levorphanol
- Lofexidine
- Loxapine
- Magnesium Oxybate
- Meperidine
- Mestranol
- Methacholine
- Methadone
- Metoclopramide
- Mexiletine
- Midazolam
- Morphine
- Morphine Sulfate Liposome
- Nalbuphine
- Norethindrone
- Norfloxacin
- Norgestimate
- Norgestrel
- Ofloxacin
- Oxycodone
- Oxymorphone
- Peginterferon Alfa-2b
- Pentazocine
- Periciazine
- Pixantrone
- Ponesimod
- Potassium Oxybate
- Pregabalin
- Propafenone
- Quetiapine
- Remifentanil
- Remimazolam
- Revefenacin
- Rofecoxib
- Scopolamine
- Secretin Human
- Sodium Oxybate
- Sufentanil
- Tapentadol
- Ticlopidine
- Tiotropium
- Tramadol
- Trazodone
- Vemurafenib
- Verapamil
- Voclosporin
- Zileuton
- Zolpidem
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Side-effects
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Dry mouth (49%)
- Sleepiness (48%)
- Weakness (41%)
- Dizziness (16%)
- Urinary tract infection (10%)
Other Side Effects
- Infections
- Constipation
- Vomiting
- Blurry vision
Serious Side Effects
Contact your healthcare provider immediately if you experience any of the following.
- Allergic reaction: trouble breathing, itchy skin or rash, closing of the throat or swelling of the tongue
When do Tizanidine (Zanaflex) possible side effects begin and end?
Time passed since treatment started:The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
- Chest pain or discomfort
- Fever or chills
- Nausea or vomiting
- Nervousness
- Pain or burning while urinating
- Unusual tiredness
Less common
- Blurred vision
- Flu-like symptoms
- Irregular heartbeat
- Itching skin
- Kidney stones
- Right upper stomach tenderness
- Seeing things that are not there
- Shortness of breath
- Weight gain
Incidence not known
- Continuing vomiting
- General feeling of tiredness or weakness
- Headache
- Light-colored stools
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
- Blurred vision
- Change in consciousness
- Chest pain or discomfort
- Confusion
- Decreased awareness or responsiveness
- Difficult or troubled breathing
- Dizziness, faintness or lightheadedness when getting up from a lying position
- Irregular, fast or slow, or shallow breathing
- Lightheadedness, dizziness, or fainting
- Loss of consciousness
- Pale or blue lips, fingernails, or skin
- Severe sleepiness
- Sleepiness or unusual drowsiness
- Slow or irregular heartbeat
- Sweating
- Unusual tiredness or weakness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
- Dizziness or lightheadedness, especially when getting up from a lying or sitting position
- Drowsiness
- Dry mouth
- Fatigue
- Sleepiness
- Weakness
Less common
- Constipation
- Nervousness
- Sore throat
Common Concerns
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