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Tizanidine oral

Updated 2 Feb 2023 | Skeletal muscle relaxants


Oral formulations of tizanidine.

Drugs List

  • TIZAGELAN 2mg tablets
  • TIZAGELAN 4mg tablets
  • tizanidine 2mg tablets
  • tizanidine 4mg tablets
  • Therapeutic Indications


    Muscle spasms
    Muscular spasticity

    Not all brands are licensed for all indications.

    Treatment of spasticity due to neurological disorders such as multiple sclerosis, spinal cord injury or disease.

    Treatment of muscle spasms caused by conditions of the spine (cervical and lumbar syndromes) or as a result of surgery on the musculoskeletal system e.g. vertebrae or hip joint.


    Dosage, including timing and frequency, should be individually determined. There is considerable variation in response between patients so careful titration is necessary.

    Abrupt discontinuation can cause rebound hypertension and tachycardia. Tizanidine should be stopped gradually.


    Spasms of the skeletal muscles
    2mg to 4mg three times daily.

    In severe cases, an extra 2mg to 4mg may be given, preferably late in the evening to reduce the sedative effect.

    Spasticity due to neurological disorders
    Initial dose: 2mg daily.
    Increase by 2mg increments in intervals of at least half a week.

    Should be given in divided doses up to 3 to 4 times daily. Total daily dose should not exceed 36mg, although optimum therapeutic response is generally achieved between 12mg and 24mg taken in 3 or 4 equally spaced doses.

    Patients with Renal Impairment

    Creatinine clearance less than 25ml/minute: 2mg once daily with slow titration (maximum 2mg increments).
    If efficacy needs to be improved the once daily dose should be increased before the frequency of administration.


    Children under 18 years
    Long QT syndrome
    Severe hepatic impairment
    Torsade de pointes

    Precautions and Warnings

    Family history of long QT syndrome
    Cardiovascular disorder
    Electrolyte imbalance
    Glucose-galactose malabsorption syndrome
    Hereditary fructose intolerance
    History of torsade de pointes
    Ischaemic heart disease
    Lactose intolerance
    Mild hepatic impairment
    Renal impairment - creatinine clearance below 25 ml/minute

    Correct electrolyte disorders before treatment
    Advise patient drowsiness may affect ability to drive or operate machinery
    Not all available brands are licensed for all indications
    Contains lactose
    Some formulations contain sucrose
    Consider monitoring ECG in patients at risk of QT prolongation
    Monitor liver function. Withdraw if evidence of hepatotoxic reaction
    Monitor renal function in patients with renal impairment
    Monitor serum electrolytes
    Advise patient to report if allergic reaction occurs
    Discontinue if hepatitis develops
    To discontinue, reduce dose gradually
    Discontinue at first signs of jaundice
    Discontinue if allergic reaction occurs
    Discontinue if ALT or AST persistently exceed 3 x ULN
    Dose adjustment required if patient starts/stops smoking during therapy
    Advise patient to avoid alcohol during treatment
    Advise patient grapefruit products may increase plasma level
    Advise patients that hallucinations can occur

    In patients who develop symptoms of hepatic dysfunction (unexplained nausea, anorexia or tiredness) liver function should be monitored. In patients taking daily doses of 12mg and above, liver function should be monitored monthly for the first 4 months.

    Pregnancy and Lactation


    Tizanidine is contraindicated during pregnancy.

    The manufacturer recommends tizanidine is not used in pregnancy unless the potential benefit to the mother outweighs the potential risk to the fetus. At the time of writing the safety of tizanidine in pregnancy has not been established. Animal data suggests toxicity but no congenital defects. It is not known if tizanidine crosses the placenta, however its relatively low molecular weight suggests that passage to the embryo or foetus should be expected. Dose related hypotension could potentially be a serious adverse effect in pregnancy. This can be minimised by careful dose titration, but close monitoring of maternal blood pressure is needed. (Briggs 2015).


    Tizanidine is contraindicated during breastfeeding.

    The manufacturer does not recommend the use of tizanidine while breastfeeding. The relatively low molecular weight and lipid solubility of tizanidine suggests excretion into breast milk will occur. Safety has not been established, but serious toxicity is a potential complication (Briggs 2015).

    Side Effects

    Abdominal pain
    Allergic reaction
    Circulatory collapse
    Decreased appetite
    Dry mouth
    Gastro-intestinal symptoms
    Hallucinations (transient)
    Hepatic failure
    Increases in serum transaminases (reversible)
    Loss of consciousness (transient)
    Muscle weakness
    Reversible confusional states
    Sleep disorders


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: February 2017

    Reference Sources

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Summary of Product Characteristics: Tizagelan 2mg tablets. Gerot Lannach UK Limited. Revised October 2021.
    Summary of Product Characteristics: Tizagelan 4mg tablets. Gerot Lannach UK Limited. Revised October 2021.

    Summary of Product Characteristics: Tizanidine 2mg tablets. Actavis UK Limited. Revised February 2016.
    Summary of Product Characteristics: Tizanidine 4mg tablets. Actavis UK Limited. Revised February 2016.

    NICE Evidence Services Available at: Last accessed: 15 December 2022

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