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cyclobenzaprine long term use

sekio

sekio

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I'm taking 10mg cyclobenzaprine (among other meds) to help loosen the tense muscles in my back. I fell out of a window and broke my spine so there is some titanium hardware in there, not to mention the injured muscles are still healing a bit. I have been taking the same dose for a few weeks now and it remains effective with nothing in the way of side effects to complain about. I just had a bit of a chat with my doctor here at the rehab clinic and he wants to reduce the dose or discontinue it because the white paper states:
FLEXERIL should be used only for short periods (up to two or three weeks) because adequate evidence of effectiveness for more prolonged use is not available and because muscle spasm associated with acute, painful musculoskeletal conditions is generally of short duration and specific therapy for longer periods is seldom warranted.

Is there any good reason not to continue the cyclobenzaprine at the same 10mg dose if it continues to provide a clear benefit to me (increased range of motion, easier time with physiotherapy etc)? My doctor really is pushing to discontinue it simply because I've been taking it for a while now. Is he just covering his ass or is there reason to be concerned?

Also, how about methocarbamol? It's OTC here so presumably it has a "better" safety profile than cyclobenzparine, but still has the same "don't take for too long because there's no good evidence" warning.
 
In the US, Kaiser, one of the major HMO's uses flexeril at 10 - 20 mg per day as its primary long term muscle relaxant, at least in our service area. It made my mouth really dry though, particularly if I was experiencing any type of stress, so I haven't used it for years.

Methocarbamol is also used for extended periods by Kaiser. It has been prescribed to me for several years now, somewhat reluctantly, because I can't take Flexeril. It makes me slightly drowsy, but it works and has continued to over time. The tablets are 750 mg.
 
sekio said:
Also, how about methocarbamol
Click to expand...

Took methocarbamol for all three of my open heart surgeries and it was an excellent addition to the opioids. Never had any issues with chronic use (3+ months) nor problems upon discontinuing.
 
Would be switching to another muscle relaxer be an option? I take tizanidine for spasms in my back, neck and right pectoral muscle; its infinitely more effect than cyclobenzaprine IMHO. I've been on it for years (4mg po 3x daily) and it hasn't lost its efficacy yet. It also has the benefits of being very clear headed and not screwing with ones proprioception.
 
my experience with cyclobenzaprine is tolerance builds VERY rapidly. 10mg would put my ass to sleep for 2-3 days... by day 5 10mg didn't do shit to me. I was prescribed it for severe muscle cramps/inflammation. I've also tried to use it recreationally before that. It certainly is not recreational - just relaxes you and puts your ass to sleep like a coma.

If it helps you I would use it only as needed due to tolerance. It's very powerful but beckons that bitch called tolerance....

just my 2 cents
 
sekio said:
I'm taking 10mg cyclobenzaprine (among other meds) to help loosen the tense muscles in my back. I fell out of a window and broke my spine so there is some titanium hardware in there, not to mention the injured muscles are still healing a bit. I have been taking the same dose for a few weeks now and it remains effective with nothing in the way of side effects to complain about. I just had a bit of a chat with my doctor here at the rehab clinic and he wants to reduce the dose or discontinue it because the white paper states:
FLEXERIL should be used only for short periods (up to two or three weeks) because adequate evidence of effectiveness for more prolonged use is not available and because muscle spasm associated with acute, painful musculoskeletal conditions is generally of short duration and specific therapy for longer periods is seldom warranted.

Is there any good reason not to continue the cyclobenzaprine at the same 10mg dose if it continues to provide a clear benefit to me (increased range of motion, easier time with physiotherapy etc)? My doctor really is pushing to discontinue it simply because I've been taking it for a while now. Is he just covering his ass or is there reason to be concerned?

Also, how about methocarbamol? It's OTC here so presumably it has a "better" safety profile than cyclobenzparine, but still has the same "don't take for too long because there's no good evidence" warning.
Click to expand...
What’s up with the pharmacology of this “cyclobenzaprine” substance? Is cyclobenzaprine an anticholinergic?
 
Flexeril, for some reason, made me prone to lose my temper. I'd snap on issues and things that weren't even aggravating.

This was a repeatable experience; it just always amounted to random, out of the blue irritability.

I would consider myself an even keeled person, especially with regard to others; however Flexeril, and at least one other muscle relaxer (the name now eludes me but I think it began with a 'g') had me being confrontationally angry with people, for no reason whatsoever. I was rude and trite: being well aware of it.

The release of letting it out wouldn't even cool me down, I'd be searing mad. It didn't roll over to the next subject, and it wasn't like I was taking anything personally, there was no rationale for it.

sekio said:
...I fell out of a window and broke my spine so there is some titanium hardware in there.
Click to expand...

Invisioning a notable scene from A Clockwork Orange. Music has been making me feel that way lately, too.
 
sekio said:
I fell out of a window
Click to expand...
The dissos told me that the ground was enlightenment

I was on methocarbamol after two musculoskeletal surgeries, seemed to help and didn't notice tolerance/withdrawal over a period of 2 weeks. Couldn't quite put my finger on the effects subjectively, but vaguely akin to GABAergic effects. Some abuse potential IMO.

I got very little effects from Baclofen at the dosages I was taking but people liked that one in physical therapy.

A certain someone who spilled something on his leg took Tizanidine for those muscle spasms/reflex sympathetic dystrophy, I personally can't tolerate the hypotension though the sleep is nice

There is some literature suggesting chronic anticholinergic use should be avoided in the elderly because of cognitive decline that is not necessarily reversible. I know this was particularly pronounced with DPH but it doesn't sound like you're having too many anticholinergic symptoms, much less "anticholinergic cognitive burden"

A Predictive In Vitro Model of the Impact of Drugs with Anticholinergic Properties on Human Neuronal and Astrocytic Systems - PMC

The link between off-target anticholinergic effects of medications and acute cognitive impairment in older adults requires urgent investigation. We aimed to determine whether a relevant in vitro model may aid the identification of anticholinergic ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
 
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I personally have used cyclobenzaprine, methocarbamol, and baclofen (individually) for extended periods of time to treat chronic pain associated with a lumbosacral transitional vertebrae. By this I mean I was on cyclobenzaprine for about 1 year at 20mg/day, then switched to methocarbamol 750mg three times daily for another year, tizanidine for a minue, then switched to baclofen 40mg daily for about 4 years. Now I'm on gabapebtin 1200mg daily instead of the muscle relaxants.

I had no bad reactions, extreme side effects, nor discontinuation effects from cyclobenzaprine or methocarbamol. I did experience baclofen withdrawal.

Anyway, in my area of the US cyclobenzaprine is the firsr tier treatment option when a muscle relaxant is indicated. Doctors always offer it first IME and ive heard the same from many people. Doctors around here seem to have no issue with long term use of cyclobenzaprine. My wife has been prescribed 30mg daily PRN for many years; she's had no negative effects resulting from regular therapeutic use.

Also, my mother is a chronic pain management patient. She is prescribed 30mg ir morphine plus 750mg methocarbamol three times daily and has been on this dosage for many years through a pain management specialist. She has had no issues result from this regimen.

I know all of this is anecdotal, but IME there's not any serious negative consequences of using cyclobenzaprine or methocarbamol in therapeutic dosages for extended periods/indefinitely. With that said, IMHO, diazepam, clonazepam, tizanidine, and baclofen provide superior muscle relaxant effects to cyclobenzaprine.

I'd be seeking a second opinion/new provider personally. He could be covering his ass. Around here cyclobenzaprine isn't something even deemed worthy of "ass covering" by doctors. With that said, they do just about anything to avoid prescribing opioids of any kind, including tramadol and codeine.
 
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On consideration, diazepam is sometimes prescribed for such conditions here in the UK... or it was 18 years ago, now they might think twice.
 
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