Cyclobenzaprine HCl

(SIGH-kloe-BEN-zuh-preen HIGH-droe-KLOR-ide)

Flexeril

Class: Skeletal muscle relaxant/Centrally acting

 Action Relieves skeletal muscle spasms of local origin without interfering with muscle function by acting within CNS at brain stem. Structurally and pharmacologically related to tricyclic antidepressants.

 Indications Relief of muscle spasms associated with acute painful musculoskeletal conditions. Unlabeled use(s): Treatment of fibrositis.

 Contraindications Use of MAO inhibitors or within 14 days of their discontinuation; acute recovery phase of MI; arrhythmias; heart block or conduction disturbances; CHF; hyperthyroidism.

 Route/Dosage

ADULTS: PO 10 mg tid (maximum 60 mg/day). Do not use > 3 wk.

 Interactions

Alcohol and other CNS depressants: May cause additive CNS depression. MAO inhibitors: May cause hyperpyretic crisis, severe convulsions and death.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Tachycardia; syncope; arrhythmias; vasodilation; palpitation; hypertension. CNS: Drowsiness; dizziness; fatigue; asthenia; headache; nervousness; convulsions; confusion. DERM: Sweating; skin rash; urticaria. EENT: Blurred vision. GI: Dry mouth; nausea; constipation; dyspepsia; unpleasant taste. HEMA: Purpura; bone marrow depression; leukopenia; eosinophilia; thrombocytopenia. META: Hypoglycemia; hyperglycemia.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy in children < 15 yr not established. Anticholinergic effects: Use with caution in patients with urinary retention, angle-closure glaucoma and increased intraocular pressure.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

• Give with meals to avoid GI irritation.
• Do not give concomitantly with MAO inhibitors or within 14 days of last dose of MAO inhibitor.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Record any sensitivity to tricyclic antidepressants and cyclobenzaprine.
• Take vital signs as needed.
• Monitor for development of psychotic symptoms (eg, disorientation, depressed mood; anxiety; hallucinations.
• Obtain ECG if heart arrhythmia develops.

OVERDOSAGE: SIGNS & SYMPTOMS   Confusion, agitation, visual hallucinations, arrhythmia, CHF, hyperpyrexia, hyperactive reflexes, vomiting, drowsiness, stupor, coma, hypothermia, tachycardia, dilated pupils, seizures, hypotension

 Patient/Family Education

• Inform patient that this medication makes injury temporarily feel better. Caution patient not to rush recovery and to avoid lifting or exercising too soon, which may further damage muscles.
• Caution patient to rise slowly from a sitting or standing position to avoid injury.
• Instruct patient to report these symptoms to physician: shortness of breath, palpitations, weight gain, heart irregularities, confusion, yellowing of skin or eyes, fever or difficulty urinating.
• Advise patient to take sips of water frequently, suck on ice chips or sugarless hard candy or chew sugarless gum if dry mouth occurs.
• Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
• Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
• Instruct patient not to take otc medications without consulting physician.

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