tizanidine (Rx)

Brand and Other Names:Zanaflex
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 2mg
  • 4mg

capsule

  • 2mg
  • 4mg
  • 6mg

Muscle Spasticity

Spasticity associated with multiple sclerosis and spinal cord injury

Initial: 2 mg PO q6-8hr PRN; no more than 3 doses q24hr

Maintenance: Titrate in 2-4 mg/day increments to optimum effect with minimum 1-4 days between dose increments

Not to exceed 36 mg/day; single doses >16 mg not studied

To discontinue taper gradually; decrease by 2-4 mg daily

Dosing Modifications

Renal impairment

  • CrCl <25 mL/min: Use caution; clearance reduced >50%
  • CrCl >25 mL/min: Not studied; use caution

Hepatic impairment

  • Close monitoring of ADRs (eg, hypotension); avoid in severe impairment

Not recommended

Next:

Interactions

Interaction Checker

and tizanidine

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            Contraindicated (0)

              Serious - Use Alternative (34)

              • abametapir

                abametapir will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP1A2 substrates. If not feasible, avoid use of abametapir.

              • amobarbital

                amobarbital will decrease the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • armodafinil

                armodafinil will decrease the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • butabarbital

                butabarbital will decrease the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • butalbital

                butalbital will decrease the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • carbamazepine

                carbamazepine will decrease the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • cigarette smoking

                cigarette smoking will decrease the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • cimetidine

                cimetidine will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • ciprofloxacin

                ciprofloxacin will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Coadministration of ciprofloxacin and tizanidine is contraindicated.

              • erythromycin base

                erythromycin base will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • erythromycin ethylsuccinate

                erythromycin ethylsuccinate will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • erythromycin lactobionate

                erythromycin lactobionate will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • erythromycin stearate

                erythromycin stearate will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • fluvoxamine

                fluvoxamine will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • givosiran

                givosiran will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP1A2 substrates with givosiran. If unavoidable, decrease the CYP1A2 substrate dosage in accordance with approved product labeling.

              • iobenguane I 131

                tizanidine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

              • isoniazid

                isoniazid will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • mefloquine

                mefloquine increases toxicity of tizanidine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

              • metoclopramide intranasal

                tizanidine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

              • mexiletine

                mexiletine will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated.

              • modafinil

                modafinil will decrease the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • pefloxacin

                pefloxacin will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • peginterferon alfa 2a

                peginterferon alfa 2a will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • pentobarbital

                pentobarbital will decrease the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • phenobarbital

                phenobarbital will decrease the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • pipemidic acid

                pipemidic acid will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated.

              • ponesimod

                ponesimod, tizanidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

              • primidone

                primidone will decrease the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • rifampin

                rifampin will decrease the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated.

              • secobarbital

                secobarbital will decrease the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • smoking

                smoking will decrease the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • tobacco use

                tobacco use will decrease the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • verapamil

                verapamil will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              • zileuton

                zileuton will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              Monitor Closely (32)

              • amifostine

                amifostine, tizanidine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

              • brexanolone

                brexanolone, tizanidine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

              • candesartan

                tizanidine increases effects of candesartan by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • cannabidiol

                cannabidiol, tizanidine. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Owing to the potential for both CYP1A2 induction and inhibition with the coadministration of CYP1A2 substrates and cannabidiol, consider reducing dosage adjustment of CYP1A2 substrates as clinically appropriate.

              • cenobamate

                cenobamate, tizanidine. Either increases effects of the other by sedation. Use Caution/Monitor.

              • citalopram

                citalopram will increase the level or effect of tizanidine by Other (see comment). Use Caution/Monitor. Monitor for increased psychomotor impairment and adverse effects.

              • clobazam

                tizanidine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

              • deferasirox

                deferasirox will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • eprosartan

                tizanidine increases effects of eprosartan by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • escitalopram

                tizanidine increases toxicity of escitalopram by pharmacodynamic synergism. Use Caution/Monitor. CNS depressants may enhance the psychomotor impairment of escitalopram.

              • esketamine intranasal

                esketamine intranasal, tizanidine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

              • ethinylestradiol

                ethinylestradiol will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Monitor for tizanidine adverse effects (eg, hypotension or bradycardia)

              • fexinidazole

                fexinidazole will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • irbesartan

                tizanidine increases effects of irbesartan by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • lasmiditan

                lasmiditan, tizanidine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

              • lemborexant

                lemborexant will increase the level or effect of tizanidine by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

              • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

                levonorgestrel oral/ethinylestradiol/ferrous bisglycinate will increase the level or effect of tizanidine by decreasing metabolism. Use Caution/Monitor. Combined oral contraceptives containing EE may inhibit the metabolism and increase plasma concentrations of cyclosporine.

              • losartan

                tizanidine increases effects of losartan by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • lurasidone

                lurasidone, tizanidine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

              • maraviroc

                maraviroc, tizanidine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

              • midazolam intranasal

                midazolam intranasal, tizanidine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

              • nitroglycerin rectal

                nitroglycerin rectal, tizanidine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Observe for possible additive hypotensive effects during concomitant use. .

              • obeticholic acid

                obeticholic acid will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. CYP1A2 substrates that have a narrow therapeutic index should be monitored closely and the dose adjusted accordingly.

              • olmesartan

                tizanidine increases effects of olmesartan by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • osilodrostat

                osilodrostat will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • rucaparib

                rucaparib will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP1A2 substrates, if clinically indicated.

              • sacubitril/valsartan

                tizanidine increases effects of sacubitril/valsartan by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • stiripentol

                stiripentol, tizanidine. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP1A2 inhibitor and inducer. Monitor CYP1A2 substrates coadministered with stiripentol for increased or decreased effects. CYP1A2 substrates may require dosage adjustment.

                stiripentol, tizanidine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

              • telmisartan

                tizanidine increases effects of telmisartan by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • teriflunomide

                teriflunomide decreases levels of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • valsartan

                tizanidine increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • vemurafenib

                vemurafenib increases levels of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Concomitant use of vemurafenib with agents with narrow therapeutic windows is not recommended as vemurafenib may alter their concentrations. If coadministration cannot be avoided, use caution and consider dose reduction of concomitant CYP1A2 substrate drug.

              Minor (79)

              • acebutolol

                tizanidine increases effects of acebutolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • alfuzosin

                tizanidine increases effects of alfuzosin by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • amiloride

                tizanidine increases effects of amiloride by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • amlodipine

                tizanidine increases effects of amlodipine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • asenapine

                tizanidine increases effects of asenapine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • atenolol

                tizanidine increases effects of atenolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • benazepril

                tizanidine increases effects of benazepril by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • bendroflumethiazide

                tizanidine increases effects of bendroflumethiazide by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • betaxolol

                tizanidine increases effects of betaxolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • bisoprolol

                tizanidine increases effects of bisoprolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • bosentan

                tizanidine increases effects of bosentan by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • bumetanide

                tizanidine increases effects of bumetanide by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • captopril

                tizanidine increases effects of captopril by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • carvedilol

                tizanidine increases effects of carvedilol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • celiprolol

                tizanidine increases effects of celiprolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • chlorothiazide

                tizanidine increases effects of chlorothiazide by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • chlorthalidone

                tizanidine increases effects of chlorthalidone by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • clevidipine

                tizanidine increases effects of clevidipine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • clonidine

                tizanidine increases effects of clonidine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • cyclopenthiazide

                tizanidine increases effects of cyclopenthiazide by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • diltiazem

                tizanidine increases effects of diltiazem by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • doxazosin

                tizanidine increases effects of doxazosin by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • drospirenone

                tizanidine increases effects of drospirenone by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • enalapril

                tizanidine increases effects of enalapril by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • eplerenone

                tizanidine increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • epoprostenol

                tizanidine increases effects of epoprostenol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • esmolol

                tizanidine increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • ethacrynic acid

                tizanidine increases effects of ethacrynic acid by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • ethinylestradiol

                ethinylestradiol increases levels of tizanidine by unspecified interaction mechanism. Minor/Significance Unknown.

              • felodipine

                tizanidine increases effects of felodipine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • fenoldopam

                tizanidine increases effects of fenoldopam by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • fosinopril

                tizanidine increases effects of fosinopril by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • furosemide

                tizanidine increases effects of furosemide by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • guanfacine

                tizanidine increases effects of guanfacine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • hydralazine

                tizanidine increases effects of hydralazine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • hydrochlorothiazide

                tizanidine increases effects of hydrochlorothiazide by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • iloprost

                tizanidine increases effects of iloprost by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • imidapril

                tizanidine increases effects of imidapril by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • indapamide

                tizanidine increases effects of indapamide by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • isradipine

                tizanidine increases effects of isradipine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • ketanserin

                tizanidine increases effects of ketanserin by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • labetalol

                tizanidine increases effects of labetalol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • lisinopril

                tizanidine increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • mecamylamine

                tizanidine increases effects of mecamylamine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • mestranol

                mestranol increases levels of tizanidine by unspecified interaction mechanism. Minor/Significance Unknown.

              • methyclothiazide

                tizanidine increases effects of methyclothiazide by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • metolazone

                tizanidine increases effects of metolazone by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • metoprolol

                tizanidine increases effects of metoprolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • metyrosine

                tizanidine increases effects of metyrosine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • minoxidil

                tizanidine increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • moexipril

                tizanidine increases effects of moexipril by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • moxisylyte

                tizanidine increases effects of moxisylyte by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • moxonidine

                tizanidine increases effects of moxonidine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • nadolol

                tizanidine increases effects of nadolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • nebivolol

                tizanidine increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • nicardipine

                tizanidine increases effects of nicardipine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • nifedipine

                tizanidine increases effects of nifedipine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • nisoldipine

                tizanidine increases effects of nisoldipine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • omeprazole

                omeprazole will decrease the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.

              • penbutolol

                tizanidine increases effects of penbutolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • perindopril

                tizanidine increases effects of perindopril by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • phenoxybenzamine

                tizanidine increases effects of phenoxybenzamine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • phentolamine

                tizanidine increases effects of phentolamine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • pindolol

                tizanidine increases effects of pindolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • prazosin

                tizanidine increases effects of prazosin by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • propranolol

                tizanidine increases effects of propranolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • quinapril

                tizanidine increases effects of quinapril by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • ramipril

                tizanidine increases effects of ramipril by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • silodosin

                tizanidine increases effects of silodosin by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • sotalol

                tizanidine increases effects of sotalol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • spironolactone

                tizanidine increases effects of spironolactone by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • terazosin

                tizanidine increases effects of terazosin by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • timolol

                tizanidine increases effects of timolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • torsemide

                tizanidine increases effects of torsemide by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • trandolapril

                tizanidine increases effects of trandolapril by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • treprostinil

                tizanidine increases effects of treprostinil by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • triamterene

                tizanidine increases effects of triamterene by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • verapamil

                tizanidine increases effects of verapamil by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • zotepine

                tizanidine increases effects of zotepine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

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              Adverse Effects

              >10%

              Dry mouth (46-50%)

              Somnolence (46-50%)

              Dizziness (16-20%)

              Asthenia (10-45%)

              1-10%

              Blurred vision (3%)

              Constipation (4%)

              Infection (6%)

              LFT abnormalities (3-5%)

              Speech disorder (3%)

              Vomiting (3%)

              Urinary frequency (3%)

              UTI (10%)

              Frequency Not Defined

              Asthenia

              Bradycardia

              Hypotension

              Orthostatic hypotension

              Syncope (rare)

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              Warnings

              Contraindications

              Hypersensitivity

              Concomitant ciprofloxacin or fluvoxamine, or other potent CYP1A2 inhibitors

              Cautions

              Potential for hypotension

              Caution in renal/hepatic impairment

              Women on oral contraceptives

              Hepatotoxicity may occur; monitor aminotransferases prior to and during use

              Sedation may occur (dose related); may potentiate effect of sedative drugs or ethanol

              Visual hallucinations may occur

              CYP1A2 inducers may decrease levels

              Rebound hypertension, tachycardia, and hypertonia reported upon abrupt discontinuation; decrease doses slowly in patients taking concomitant narcotics or high doses (20-28 mg/day) for prolonged periods

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              Pregnancy & Lactation

              Pregnancy

              There are no adequate data on developmental risk associated with use in pregnant women

              Reproductive potential

              • There are no adequate and well-controlled studies in humans on effect of drug on female or male reproductive potential; oral administration of to male and female rats resulted in adverse effects on fertility

              Animal data

              • In animal studies, administration of drug during pregnancy resulted in developmental toxicity (embryofetal and postnatal offspring mortality and growth deficits) at doses less than those used clinically, which were not associated with maternal toxicity

              Lactation

              There are no data on presence of drug in human milk, effects on breastfed infant, or on human milk production; animal studies have reported the presence of drug in milk of lactating animals

              The developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for drug and any potential adverse effects on breastfed infant from drug or from underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Alpha-2 adrenergic receptor agonist structurally related to clonidine; increases presynaptic inhibition of motor neurons

              Absorption

              Bioavailability: 40%

              Peak serum time: 1-4 hr

              Distribution

              Protein bound: 30%

              Vd: 2.4 L/kg

              Metabolism

              Extensively metabolized in the liver

              Elimination

              Half-life: 2.5 hr

              Excretion: Feces (20%); urine (60%)

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              tizanidine oral
              -
              6 mg capsule
              tizanidine oral
              -
              4 mg capsule
              tizanidine oral
              -
              2 mg capsule
              tizanidine oral
              -
              2 mg tablet
              tizanidine oral
              -
              4 mg tablet
              tizanidine oral
              -
              4 mg tablet
              tizanidine oral
              -
              2 mg tablet
              tizanidine oral
              -
              2 mg tablet
              tizanidine oral
              -
              4 mg tablet
              tizanidine oral
              -
              2 mg tablet
              tizanidine oral
              -
              2 mg tablet
              tizanidine oral
              -
              4 mg tablet
              tizanidine oral
              -
              4 mg tablet
              tizanidine oral
              -
              4 mg tablet
              tizanidine oral
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              2 mg capsule
              tizanidine oral
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              4 mg capsule
              tizanidine oral
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              6 mg capsule
              tizanidine oral
              -
              6 mg capsule
              tizanidine oral
              -
              4 mg capsule
              tizanidine oral
              -
              2 mg capsule
              tizanidine oral
              -
              4 mg capsule
              tizanidine oral
              -
              6 mg capsule
              tizanidine oral
              -
              2 mg capsule
              tizanidine oral
              -
              2 mg tablet
              tizanidine oral
              -
              6 mg capsule
              tizanidine oral
              -
              4 mg capsule
              tizanidine oral
              -
              2 mg capsule
              Zanaflex oral
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              2 mg capsule
              Zanaflex oral
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              6 mg capsule
              Zanaflex oral
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              4 mg capsule
              Zanaflex oral
              -
              4 mg tablet

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              tizanidine oral

              TIZANIDINE - ORAL

              (tye-ZAN-i-deen)

              COMMON BRAND NAME(S): Zanaflex

              USES: This medication is used to treat muscle spasms caused by certain conditions (such as multiple sclerosis, spinal cord injury). It works by helping to relax the muscles.

              HOW TO USE: Take this medication by mouth as directed by your doctor, usually every 6 to 8 hours.The dosage is based on your medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. Do not take more than 36 milligrams a day or more than 3 doses in a 24-hour period.Your body will absorb this medication differently depending on whether you take it as a tablet or capsule, whether you take it with food or on an empty stomach, or if you sprinkle the contents of the capsule on food. Be sure to discuss with your doctor how to take this medication to determine the best way to take your dose, especially when changes to your dose are being considered or if your doctor prescribes a different form of tizanidine (such as tablet or capsule).If you suddenly stop using this medication, you may have withdrawal symptoms (such as anxiety, tremor, increased blood pressure/heart rate/muscle tenseness). To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used tizanidine for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal.Tell your doctor if your condition does not improve or if it worsens.

              SIDE EFFECTS: Dry mouth, drowsiness, dizziness, lightheadedness, constipation, weakness, and tiredness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.To relieve dry mouth, suck (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: fainting, mental/mood changes (such as hallucinations), slow/irregular heartbeat, vision changes (such as blurred vision).Tizanidine has rarely caused very serious (rarely fatal) liver disease. Tell your doctor right away if you develop symptoms of liver disease, including: persistent nausea/vomiting, severe stomach/abdominal pain, dark urine, yellowing eyes/skin.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking tizanidine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: low blood pressure, kidney disease, liver disease.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially dizziness and drowsiness. These effects can increase the risk of falling.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: certain drugs to treat high blood pressure (alpha agonists such as clonidine, methyldopa).Other medications can affect the removal of tizanidine from your body, which may affect how tizanidine works. Examples include birth control pills, ciprofloxacin, fluvoxamine, viloxazine, among others.Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), other muscle relaxants, and opioid pain relievers (such as codeine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness/drowsiness, confusion, slow/shallow breathing, fainting.

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as blood pressure, liver function) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.