Tizanidine

Tizanidine is a potent muscle relaxer that helps to relieve muscle spasms, muscle cramps, and muscle tightness. Generally, tizanidine is prescribed to individuals living with MS (multiple sclerosis) and people who have severe spine injuries.

As part of a class of medications termed skeletal muscle relaxants, tizanidine is FDA approved and prescribed for managing spasticity. 

Tizanidine works by reducing or slowing activity in the nervous system as well as in the brain, which results in muscle relaxation.

Tizanidine Uses

Individuals who use tizanidine might experience spasms and increased muscle tone that is often symptomatic of MS. Nerves may not be functioning properly, causing the individual to experience the following symptoms: 

• Numbness
• Weakness
• Loss of coordination
• Loss of mobility
• Vision problems 
• Speech problems
• Bladder control issues

Tizanidine comes as either a tablet or capsule. It is taken two to three times daily – either with or without food, depending on the specific labeling instructions. Users should take tizanidine consistently and use the same exact protocol with each dosage. 

Dosage Levels

Tizanidine comes in either a 2 mg or 4 mg tablet as well as either a 2 mg, 4 mg, or 6 mg capsule. Initially, individuals receive a 2 mg dose no more than three times per 24-hour period.

Maintenance dosage is generally 2 mg to 4 mg per day. Dosages should not exceed 36 mg in a 24-hour period.

When discontinuing use, it is best to taper off tizanidine in a gradual way, decreasing by 2 mg to 4 mg each day until discontinuation has been completed.

If an individual misses a dose, it’s best to take the dose as soon as this is realized. However, if the time for the next dose is in close proximity to the missed dose, it is best to skip the missed dose and continue treatment. It is not recommended to attempt to “make up” for a missed dose of tizanidine.

This medication should be stored away from children. It’s important to keep tizanidine in the container you received it in and store in a secure place in the house that is room temperature. Do not keep this medication in the bathroom. It needs to be kept away from moisture and heat.

Tizanidine Side Effects

Tizanidine may cause side effects and adverse events, so it’s important to do your research and know your own personal health history and situation before exploring tizanidine for treatment.

Side effects of taking Tizanidine include the following:

• Nausea
• Drowsiness
• Diarrhea
• Constipation
• Tingling of the extremities (arms, legs, feet, and hands)
• Depression
• Rash
• Sweating

Some of the more serious side effects of tizanidine include the following:

• Bleeding or bruising
• Pain in the abdomen (upper right portion of the stomach)
• Flu-like symptoms
• Yellowing of the eyes and skin (jaundice)
• Hallucination (hearing or seeing nonexistent things)

If you or someone you know is experiencing serious side effects, seek medical attention as soon as possible.

Signs of Tizanidine Overdose

It is possible to overdose on tizanidine. Overdose symptoms include the following:

• Drowsiness
• Respiratory issues (shallow breathing)
• Feelings of lightheadedness
• Slowed heart rate
• Fainting or collapse
• Loss of consciousness
• Seizure

If you or someone you know has overdosed on tizanidine, you need prompt medical care. Call 911 for emergency help if someone experiences bleeding, loss of consciousness, or seizures.

Tizanidine Interactions

It’s important not to take tizanidine if you will be active or require normal balance and mobility. Avoid driving while taking tizanidine as well as operating any sort of heavy machinery. Reaction times can be slowed, and senses can be impaired while on the medication. 

Alcohol

Drinking any type of alcoholic beverage while on tizanidine can cause severe adverse events and side effects. Individuals who drink alcohol while taking tizanidine can experience dangerous symptoms like loss of consciousness, respiratory failure, and even coma or death.

Marijuana

The use of marijuana can also alleviate and intensify drowsiness symptoms brought on by tizanidine. The use of other muscle relaxants can cause interactions as well.

Other Drugs & Prescribed Medications

Other prescribed medications that tizanidine can potentially interact with include birth control pills, fluvoxamine, and viloxazine among other medications. Tizanidine can potentially interact with antihistamines as well as medications for insomnia and anxiety. Tizanidine also has the potential to interact with opioids and other pain relief agents, such as codeine.

Taking tizanidine with any other form of narcotic can significantly increase the chances of abuse and addiction. If you take tizanidine, you should always follow prescription guidelines and stop use when the drug is no longer needed.

Signs of Tizanidine Abuse

According to NIH, addiction to tizanidine happens when average doses exceed 20 mg to 36 mg. Due to tizanidine’s potency, there is a risk of abuse for individuals who use this medication for treatment. 

Tizanidine abuse symptoms include the following:

• Frequent runny nose
• Nausea or flu-like symptoms
• Problems with urination
• Blurred vision
• Irritability
• Drug-seeking behavior
• Drowsiness or weakness

Other signs of tizanidine abuse include forging prescriptions, seeking multiple doctors in order to obtain multiple prescriptions, and social withdrawal or lack of engagement in daily activities and normal routines.

Tizanidine withdrawal can occur, which results in a variety of symptoms if you suddenly stop use of the medication. Symptoms can include high blood pressure, high heart rate, tremors, increased anxiety, muscle stiffness, and irritability.

Although tizanidine is absorbed through the body in a short amount of time, those who use the medication in higher doses might experience kidney and liver problems that can extend the timeline of withdrawal symptoms. The use of alcohol in conjunction with this drug can often diminish the body’s ability to engage in the detoxification process. 

Treatment for Tizanidine Addiction

There is no proven antidote for tizanidine intoxication. Treatment for Tizanidine intoxication includes intravenous fluid administration, vasopressors (if necessary), as well as endotracheal intubation. 

Detox & Therapy

Treatment for tizanidine addiction, withdrawal, and abuse is provided in a variety of ways, as it is for many other prescription and illicit drugs. Addiction treatment often includes medical intervention, such as drug detox with professional supervision. 

Various therapies have also been shown to be beneficial for the treatment of addiction, such as cognitive behavioral therapy (CBT).

Group Support

Individuals who suffer from tizanidine addiction can explore peer support groups, such as 12-step groups like Narcotics Anonymous. These groups provide continuous support and guidance, and participation can significantly reduce the likelihood of relapse. 

The structure and principles of 12-step groups don’t appeal to some people, so there are many alternatives available. The key is to find some form of ongoing support that can help to maintain long-term recovery.

References

Tizanidine. (January 2022). StatPearls.

Tizanidine. (November 2015). American Society of Health-System Pharmacists.

Risk of Tizanidine-Induced Adverse Events After Concomitant Exposure to Ciprofloxacin: A Cohort Study in the U.S. (May 2022). The American Journal of Emergency Medicine.

Using Clonidine in the Treatment of Tizanidine Abuse and Withdrawal: A Case Report of a patient With Somatoform Pain Disorder. (March 2020). Journal of Substance Use.

Management of Tizanidine Withdrawal Syndrome: A Case Report. (February 2018). Clinical Medicine Insights: Case Reports.