- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Oral formulations of tizanidine.
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
Glucose-galactose malabsorption syndrome
Hereditary fructose intolerance
History of torsade de pointes
Ischaemic heart disease
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
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).
Increases in serum transaminases (reversible)
Loss of consciousness (transient)
Reversible confusional states
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 ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Last Full Review Date: February 2017
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: www.nice.org.uk Last accessed: 15 December 2022
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Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.