Orphenadrine Citrate

(ore-FEN-uh-dreen SIH-trate)

Banflex, Flexoject, Flexon, Norflex

Class: Skeletal muscle relaxant/centrally acting

 Action Unknown; may be related to analgesic properties since drug acts on brain stem and does not act directly on muscles; possesses anticholinergic actions.

 Indications Adjunctive treatment for acute, painful musculoskeletal conditions. Unlabeled use(s): Treatment of quinine-resistant leg cramps.

 Contraindications Glaucoma; pyloric or duodenal obstruction; stenosing peptic ulcers; prostatic hypertrophy; obstruction of bladder neck; esophageal achalasia; myasthenia gravis.

 Route/Dosage

ADULTS: IV/IM 60 mg q 12 hr prn. PO 100 mg bid.

 Interactions

Alcohol, other CNS depressants: Increased CNS depression. Haloperidol: Worsening schizophrenic symptoms, decreased haloperidol levels, tardive dyskinesia. Phenothiazines: Decreased effects of phenothiazines.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Tachycardia; palpitations; transient syncope. CNS: Weakness; headache; dizziness; lightheadedness; confusion (especially in elderly); hallucinations; agitation; tremor; drowsiness. DERM: Hypersensitivity reactions (eg, rashes). EENT: Blurred vision; pupil dilation; increased ocular tension. GI: Dry mouth; vomiting; nausea; constipation; gastric irritation. GU: Urinary hesitancy and retention.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Elderly patients: May be more sensitive to anticholinergic effects. Cardiac disease: Use drug with caution in patients with cardiac decompensation, coronary insufficiency, cardiac arrhythmias or tachycardia. Heat prostration: Can occur in presence of high environmental temperature. Hypersensitivity reactions: May occur. Sulfite sensitivity: Some products contain bisulfites, which may cause allergic-type reactions in certain persons.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

• Do not crush or have patient chew sustained-release preparations.
• Give IV solution over 5 min with patient in supine position. Administer carefully; intoxication is very rapid and can be lethal.
• Store at room temperature.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Monitor patient’s vital signs.
• Monitor blood, urine, and liver function values during long-term therapy.
• Assess degree of pain relief obtained.
• Implement safety precautions if patient becomes drowsy or dizzy.
• Notify physician if rapid heart rate, palpitations, or mental confusion occurs.
• Carefully document voiding.

OVERDOSAGE: SIGNS & SYMPTOMS   Cardiac arrhythmias, seizures, coma, shock

 Patient/Family Education

• Tell patient not to increase dosage of medication. Even slight overdose may be highly toxic.
• Instruct patient to take sips of water frequently, suck on ice chips or sugarless hard candy, or chew sugarless gum if dry mouth occurs.
• Advise patient that drug may cause drowsiness or dizziness, and to use caution while driving or performing other tasks requiring mental alertness.
• Instruct patient to report the following symptoms to physician: Urinary retention, constipation, palpitations, or tremors.
• Instruct patient to avoid alcohol or other CNS depressants.

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