Tizanidine is a skeletal muscle relaxant used for its anti-spastic effect in the treatment of several conditions, or is sometimes used off-label for its sedating and analgesic effects in pain and sleep conditions. Tizanidine can be prescribed in varying doses depending on the condition being treated, and effects may differ due to the dose.
- Tizanidine is a muscle relaxant used to treat muscle spasms and pain, which can also be prescribed off-label to manage conditions relating to pain and sleep issues.
- Tizanidine is often started on a low dose that can be increased gradually, as side effects may be dose dependent.
- Always take tizanidine exactly as prescribed. Doses will vary depending on the individual, the condition being treated, and any underlying physical health issues.
Tizanidine prescription uses
Tizanidine is a skeletal muscle relaxant that can be prescribed to treat spasticity in the context of various conditions, including multiple sclerosis, stroke, traumatic brain injury, cerebral palsy, and spinal injuries. It is approved by the Food and Drug Administration (FDA) for this purpose. [1]
It can also be used effectively for various off-label purposes, meaning those that are not approved by the FDA. This includes pain conditions, particularly back and neck pain, insomnia, and migraines. In recent studies, it has shown some potential for possibly being an effective treatment in the management of substance withdrawal symptoms, though more research is needed. [1][2]
Tizanidine doses
Typically, tizanidine will be commenced on a low dose, which can be gradually increased as necessary. This dose can vary depending on the condition being treated and the individual’s needs and response to the medication.
Treatment will often start with a 2 mg dose, the effects of which peak after 1-2 hours and begin to reduce after 3-6 hours. This dose can be repeated after 6 to 8 hours if needed, up to a maximum of three doses per day. [3]
To reach the most effective therapeutic dosage, each dose can be increased by 2 to 4 mg every 1-4 days, until satisfactory improvements are seen.
Gradually increasing the dose can help to reduce the occurrence of side effects. Higher doses are more likely to produce side effects. [3]
Tizanidine max single dose
The recommended maximum single dose is 8 mg. Single doses above 8 mg, such as 16 mg, are not routinely recommended due to limited safety data and increased risk of side effects, and should only be considered under strict medical supervision. [3]
Tizanidine max daily dose
The maximum recommended daily dose of tizanidine is 36 mg per 24 hours, divided into three doses. The maximum daily dose may be adjusted depending on the individual. For example, young or elderly patients, or those with physical health conditions, may be limited to a much lower daily dose. In some cases, a higher daily dose is necessary if lower doses are ineffective. [1][3]
High doses are more likely to produce side effects and risks of dependence and addiction.
Is there a recommended tizanidine dose for sleep?
Tizanidine is not approved to treat sleep disorders and insomnia, and, as such, there is no recommended dosage. People using tizanidine for sleep should follow their doctor’s advice if they are prescribed this medication off-label. Typically, it can be a helpful treatment when used in low doses, to be taken before bedtime. This dose can be slowly increased if needed.
Precautions and risks
Tizanidine may need to be used in reduced doses or with caution in the following populations: [1][3]
- People with a history of liver or kidney disease
- People who are pregnant or breastfeeding
- People with a history of low blood pressure
Tizanidine can cause drowsiness and sedation. People should not drive when using the medication until they know how it will affect them. People should be careful when standing from a lying or sitting position, as they may experience dizziness and falls. [4]
Some people experience psychotic symptoms such as hallucinations when commencing tizanidine. It may be beneficial to reduce the dose or stop the medication if these symptoms occur. [3]
Proper use
Tizanidine is only available with a doctor’s prescription and should only be taken when it has been prescribed and dispensed by licensed professionals. It should be taken as directed, in the correct form, dose, and time. Never take more tizanidine than prescribed.
Storage
Tizanidine should be stored in a safe place, where it cannot be accessed by children or pets. It should not be shared with others, even those who have similar symptoms, as it should only be used with professional guidance and a prescription. It may cause harmful effects if someone without a prescription uses tizanidine.
Allergies
Sometimes, people may be allergic to tizanidine, and its use can cause anaphylaxis. Signs of an allergic reaction could include difficulty breathing, swelling of the throat or mouth, and rash or hives. Contact a doctor and/or call 911 immediately if these symptoms emerge. [3][4]
Interactions
Tizanidine can react with other medications and substances if used together. This can lead to adverse effects or a change in the effectiveness of the medications.
It is not recommended to use tizanidine alongside other alpha-2 adrenergic agonists, such as clonidine, dexmedetomidine, or lofexidine, as this can cause an increased risk of adrenergic side effects. [3]
Tizanidine should not be used alongside fluvoxamine or ciprofloxacin, as this can increase the risk of hypotension due to increased levels of tizanidine in the blood. Other interactions can include heart medications, antihistamines, oral contraceptives, and acyclovir. [3][4]
Before starting a new medication, the prescribing doctor needs to be aware of recent and current medications to ensure dangerous interactions do not occur when commencing tizanidine treatment.
Tizanidine overdose
Someone who intentionally or unintentionally takes a higher dose of tizanidine than prescribed may be at risk of overdose. Additionally, combining tizanidine with other substances, particularly central nervous system (CNS) depressants, such as alcohol, benzodiazepines, and opioids, can significantly increase the risk of overdose. [3]
Signs of tizanidine overdose can include: [3][4]
- Extreme fatigue
- Feeling sleepy
- Breathing difficulties
- Dizziness
- Fainting
- Extreme change in heartbeat
- Loss of consciousness
If it is an emergency, such as if the individual is struggling to breathe, cannot be roused, or has a seizure, call 911 immediately. If a tizanidine overdose is suspected and does not pose an immediate threat to their safety, call Poison Control at 1-800-222-1222 for advice.
When to consult a doctor regarding tizanidine dosage
During treatment, the doctor will arrange regular medication reviews to ensure the effectiveness and safety of the medication and adjust treatment if required. It may be necessary to contact a doctor in between these reviews. If symptoms are not being managed effectively, the dosage may be too low, or if adverse effects are occurring, the dosage may be too high.
Never make changes to your dosage without first consulting a doctor. Always take tizanidine exactly as it has been prescribed.
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