The site of the Media Sphera Publishers contains materials intended solely for healthcare professionals.
By closing this message, you confirm that you are a certified medical professional or a student of a medical educational institution.

Login
EN
+7 (495) 482-4118
+7 (495) 482-0604
+8 800 250-18-12
  • (toll-free number for subscriptions)
    Mon-Fri from 10 a.m. to 6 p.m.

  • © 1998-2025
+7 (495) 482-43-29
EN
All journals
Journal
Year
Year
Search result: 0

Titova N.V.

Pirogov Russian National Research Medical University;
Federal Center for Brain and Neurotechnology

Putyatin I.A.

Pirogov Russian National Research Medical University

Muscle relaxant selection criteria for musculoskeletal pain

Authors:

Titova N.V., Putyatin I.A.

More about the authors

Journal: Russian Journal of Pain. 2024;22(4): 55‑64

DOI: 10.17116/pain20242204155

Read: 1999 times

Download PDF (RU)
Contact the author
Table of contents

MUSCLE RELAXANT SELECTION CRITERIA FOR MUSCULOSKELETAL PAIN
MUSCLE RELAXANT SELECTION CRITERIA FOR MUSCULOSKELETAL PAIN

To cite this article:

Titova NV, Putyatin IA. Muscle relaxant selection criteria for musculoskeletal pain. Russian Journal of Pain. 2024;22(4):55‑64. (In Russ.)
https://doi.org/10.17116/pain20242204155

 
Подписка 2025 Российский журнал боли (Russian Journal of Pain)
МСФ на ЯМ
Использование инфографики авторами научных работ
Close metadata
Recommended articles:
The Keele stra­tification tool for targeted treatment of musculoskeletal pain (Keele STarT MSK Tool): linguistic adaptation of the Russian-language version. Russian Journal of Pain. 2024;(4):30-34
Sano­genetic mechanisms of cyclic local traction therapy in the treatment of neurological mani­festations of dege­nerative diseases in the spine. (Literature review). Problems of Balneology, Physiotherapy and Exercise Therapy. 2024;(5):74-83
Control of neuropathic pain in lumbosacral dorsalgia. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(11):152-157
The resu­lts of a multicenter open obse­rvational study of the effi­cacy and safety of the dietary supplement Neururidine N in patients with acute nonspecific lower back pain in daily outpatient practice (the NEURO-N study). S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(11):158-164
Chondroprotective therapy and adju­vant support for patients with chro­nic lower back pain. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(12):120-125
Influence of local anesthesia methods on the resu­lts of radiofrequency facet dene­rvation. Burdenko's Journal of Neurosurgery. 2025;(2):57-61
Deve­lopment of conditions for dete­rmination of imidazole deri­vatives in the blood using chro­matography-mass spectrometry. Fore­nsic Medi­cal Expe­rtise. 2025;(3):32-37
Risk factors for low back pain in healthcare professionals taking care for patients with redu­ced mobi­lity. Russian Journal of Preventive Medi­cine. 2025;(7):75-80
On the resu­lts of a multicenter, open, obse­rvational, non-interventional study of the effi­cacy and safety of nime­sulide (Nise) in combination with muscle rela­xants in patients with acute back pain. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(7):82-88
Abstract:

Central muscle relaxants (tolperisone, tizanidine, cyclobenzaprine) are prescribed according to modern clinical recommendations for relief of painful muscle spasm in musculoskeletal low back pain. To date, there are no differences in efficacy between different muscle relaxants in patients with acute and chronic low back pain. This fact actualizes the problem of choosing a specific muscle relaxant. When choosing a central muscle relaxant in a patient with low back pain, one should consider drug action mechanism, potential side effects, acceptability of side effects (patient’s lifestyle, type of activity), effect on driving, age, comorbidities, possible drug interactions, harmful habits (smoking, possibility of combination with alcohol), convenience of intake, risk of withdrawal syndrome, personal experience and preferences of physician, as well as patient’s preferences after previous treatment. The review describes the unique characteristics of different central muscle relaxants and individual patient characteristics, which should be considered to select optimal treatment.

Keywords:

low back pain
musculoskeletal pain
central muscle relaxant
tolperisone
tizanidine
cyclobenzaprine

Authors:

Titova N.V.

Pirogov Russian National Research Medical University;
Federal Center for Brain and Neurotechnology

Putyatin I.A.

Pirogov Russian National Research Medical University

Received:

04.09.2024

Accepted:

07.09.2024

Close metadata

References:

  1. Klinicheskie rekomendatsii. Skeletno-myshechnye (nespetsificheskie) boli v nizhnej chasti spiny. Mezhregional’naya obshchestvennaya organizatsiya «Obshchestvo po izucheniyu boli». 2023. (In Russ.). Accessed August 26, 2024. https://painrussia.ru/upload/pdf/KP778.pdf
  2. van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. 2003;2003(2):CD004252. https://doi.org/10.1002/14651858.CD004252
  3. Shaheed CA, Maher CG, Williams KA, McLachlan AJ. Efficacy and tolerability of muscle relaxants for low back pain: Systematic review and meta‐analysis. European Journal of Pain. 2016;21(2):228-237.  https://doi.org/10.1002/ejp.907
  4. Chang WJ. Muscle relaxants for acute and chronic pain. Physical Medicine and Rehabilitation Clinics of North America. 2020;31(2):245-254. 
  5. Kukushkin ML, Brylev LV, Laskov VB, Makarov NS, Pizova NV, Sokov EL, Chefranova ZhYu, Sholomov II, Guekht AB. Results of a randomized double blind parallel study on the efficacy and safety of tolpersione in patients with acute nonspecific low back pain. S.S. Korsakov Journal of Neurology and Psychiatry. 2017;117(11):69-78. (In Russ.). https://doi.org/10.17116/jnevro201711711169-78
  6. Pareek A, Chandurkar N, Chandanwale AS, Ambade R, Gupta A, Bartakke G. Aceclofenac-tizanidine in the treatment of acute low back pain: a double-blind, double-dummy, randomized, multicentric, comparative study against aceclofenac alone. European Spine Journal. 2009;18(12):1836-1842. https://doi.org/10.1007/s00586-009-1019-4
  7. Pratzel HG, Alken RG, Ramm S. Efficacy and tolerance of repeated oral doses of tolperisone hydrochloride in the treatment of painful reflex muscle spasm: results of a prospective placebo-controlled double-blind trial. Pain. 1996 Oct;67(2-3):417-425. PMID: 8951937. https://doi.org/10.1016/0304-3959(96)03187-9
  8. Ji Q, Yi D, Wang J, et al. Expert consensus on management of chronic musculoskeletal pain in older adults. Chinese Journal of Geriatrics. 2019;38(2):500-507.  https://doi.org/10.3760/cma.j.issn.0254-9026.2019.05.008
  9. Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians; Denberg, TD, Barry MJ, Boyd C, Chow RD, Fitterman N, Harris RP, Humphrey LL, Vijan S. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine. 2017;166(7):514-530.  https://doi.org/10.7326/M16-2367
  10. Chou R, Peterson K, Helfand M. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: a systematic review. Journal of Pain and Symptom Management. 2004;28(2):140-175.  https://doi.org/10.1016/j.jpainsymman.2004.05.002
  11. Abril L, Zamora C, Cordero M, Williams AR, Friedman BW. The relative efficacy of seven skeletal muscle relaxants. An analysis of data from randomized studies. Journal of Emergency Medicine. 2022;62(4):455-461.  https://doi.org/10.1016/j.jemermed.2021.09.025
  12. Roland M, Morris R. A study of the natural history of back pain. Spine. 1983;8(2):141-144.  https://doi.org/10.1097/00007632-198303000-00004
  13. Fels G. Tolperisone: Evaluation of the Lidocaine‐Like Activity by Molecular Modeling. Archiv Der Pharmazie. 1996;329(4):171-178.  https://doi.org/10.1002/ardp.19963290402
  14. Quasthoff S, Möckel C, Zieglgänsberger W, Schreibmayer W. Tolperisone: a typical representative of a class of centrally acting muscle relaxants with less sedative side effects. CNS Neurosci Ther. 2008;14(2):107-119.  https://doi.org/10.1111/j.1527-3458.2008.00044.x
  15. Kocsis P, Farkas S, Fodor L, Bielik N, Thán M, Kolok S, Gere A, Csejtei M, Tarnawa I. Tolperisone-Type drugs inhibit spinal reflexes via blockade of Voltage-Gated sodium and calcium channels. Journal of Pharmacology and Experimental Therapeutics. 2005;315(3):1237-1246. https://doi.org/10.1124/jpet.105.089805
  16. Farkas S, Tarnawa I, Berzsenyi P. Effects of some centrally acting muscle relaxants on spinal root potentials: a comparative study. Neuropharmacology. 1989;28(2):161-173.  https://doi.org/10.1016/0028-3908(89)90053-1
  17. Okada H, Honda M, Ono H. Method for recording spinal reflexes in mice: Effects of Thyrotropin-Releasing Hormone, DOI, tolperisone and baclofen on monosynaptic spinal reflex potentials. The Japanese Journal of Pharmacology. 2001;86(1):134-136.  https://doi.org/10.1254/jjp.86.134
  18. Kukushkin ML. Tolperisone: mechanism of action, clinical efficacy and safety in the treatment of musculoskeletal pain. Russian Journal of Pain. 2022;20(2):63-67. (In Russ.). https://doi.org/10.17116/pain20222002163
  19. Titova NV. Tolperisone for the treatment of low back pain. Klinicheskaya farmakologiya i terapiya. 2022;31(2):14-19. (In Russ.). https://doi.org/10.32756/0869-5490-2022-2-14-19
  20. Kukushkin ML. Sovremennyj vzglyad na mekhanizm dejstviya Midokalma. Consilium Medicum. 2013;15(2):89-94. (In Russ.).
  21. Sakitama K. The effects of centrally acting muscle relaxants on the intrathecal noradrenaline-induced facilitation of the flexor reflex mediated by group II afferent fibers in rats. Jpn J Pharmacol. 1993;63(3):369-376.  https://doi.org/10.1254/jjp.63.369
  22. Sakaue A, Honda M, Tanabe M, Ono H. Antinociceptive effects of sodium Channel-Blocking agents on acute pain in mice. Journal of Pharmacological Sciences. 2004;95(2):181-188.  https://doi.org/10.1254/jphs.fpj03087x
  23. Furuta Y, Yoshikawa A. Reversible adrenergic Α-Receptor blocking action of 2,4’-Dimethyl-3-Piperidino-Propiophenone (Tolperisone). The Japanese Journal of Pharmacology. 1976;26(5):543-550.  https://doi.org/10.1254/jjp.26.543
  24. Briskin BS, Dibirov MD, Evseev YuN, Novoseltsev OS. Treatment of chronic arterial insufficiency of the lower extremities with midocalm in elderly and senile patients. Surgery. 2000;4:52-54. (In Russ.).
  25. Briskin BS, Sakunova TI, Proshin AV, Yakobishvili YaI. Midocalm in the complex treatment of patients with diabetic foot syndrome. Clinical Gerontology. 2000;34:34-38. (In Russ.).
  26. Devlikamova FI. Results of the post-registration study «PARUS» to assess the efficacy and safety of the drug Midocalm-Richter in local injection therapy of the myofascial trigger zone. Therapeutic Archive. 2018;6:81-88. (In Russ.). https://doi.org/10.26442/terarkh201890681-88
  27. Henney HR, Chez M. Pediatric safety of tizanidine. Pediatric Drugs. 2009;11(6):397-406. 
  28. Chapman CR, Bradshaw DH, Donaldson GW, Jacobson RC, Nakamura Y. Central noradrenergic mechanisms and the acute stress response during painful stimulation. Journal of Psychopharmacology. 2014;28(12):1135-1142. https://doi.org/10.1177/0269881114543718
  29. Coward DM. Tizanidine: neuropharmacology and mechanism of action. Neurology. 1994;44(11 Suppl 9):S6-S11.  https://pubmed.ncbi.nlm.nih.gov/7970012
  30. Delwaide PJ, Pennisi G. Tizanidine and electrophysiologic analysis of spinal control mechanisms in humans with spasticity. Neurology. 1994;44 (11 Suppl 9):S21-S28.  https://pubmed.ncbi.nlm.nih.gov/7970007
  31. Segall SK, Maixner W, Belfer I, Wiltshire T, Seltzer Z, Diatchenko L. Janus molecule I: dichotomous effects of COMT in neuropathic vs nociceptive pain modalities. CNS Neurol Disord Drug Targets. 2012;11(3):222-235.  https://doi.org/10.2174/187152712800672490
  32. Yakhno NN, Amelin AV, Akhmadeeva LR, Barantsevich ER, Bykov YuN, Vorobeva OV, Volkova LI, Davydov OS, Danilov AB, Devlikamova FI, Doronina OV, Iskra DA, Kamchatnov PR, Karakulova YuV, Kukushkin ML, Kurushina OV, Parfenov VA, Poverennova IE, Rachin AP, Churyukanov MV, Shirokov VA, Yakupov EZ. Cyclobenzaprine: new option for pharmacological therapy of back pain. Expert panel opinion. Russian Journal of Pain. 2023;21(1):88-94. (In Russ.). https://doi.org/10.17116/pain20232101188
  33. Cimolai N. Cyclobenzaprine: a new look at an old pharmacological agent. Expert Review of Clinical Pharmacology. 2009;2(3):255-263.  https://doi.org/10.1586/ecp.09.5
  34. Honda M, Nishida T, Ono H. Tricyclic analogs cyclobenzaprine, amitriptyline and cyproheptadine inhibit the spinal reflex transmission through 5-HT(2) receptors. European Journal of Pharmacology. 2003;458(1-2):91-99.  https://doi.org/10.1016/s0014-2999(02)02735-8
  35. Kobayashi H, Hasegawa Y, Ono H. Cyclobenzaprine, a centrally acting muscle relaxant, acts on descending serotonergic systems. European Journal of Pharmacology. 1996;311(1):29-35.  https://doi.org/10.1016/0014-2999(96)00402-5
  36. Kuznetsova LV, Karpova MN, Klishina NYu, Kukushkin ML. Effect of cyclobenzaprine on the dynamics of neuropathic pain syndrome development in Wistar male rats. Russian Journal of Pain. 2022;20(3):5-9. (In Russ.). https://doi.org/10.17116/pain2022200315
  37. Brown EG, Wood L, Wood S. The medical dictionary for regulatory activities (MedDRA). Drug Saf. 1999;20(2):109-117. 
  38. Instruction for medical use of medicinal product Midocalm, P N002409/01 of 09.10.2008. (In Russ.).
  39. Prabhoo R, Keny S, Prabhoo T, Singh A, Rana R. A phase IV observational multi-centre, open-label study on efficacy and safety of tolperisone 150 mg in patients with painful muscle spasm associated with degenerative or inflammatory diseases of the musculoskeletal system. J Assoc Physicians India. 2011;59:33-37.  https://pubmed.ncbi.nlm.nih.gov/21751662
  40. Stamenova P, Koytchev R, Kuhn K, Hansen C, Horvath F, Ramm S, Pongratz D. A randomized, double‐blind, placebo‐controlled study of the efficacy and safety of tolperisone in spasticity following cerebral stroke. European Journal of Neurology. 2005;12(6):453-461.  https://doi.org/10.1111/j.1468-1331.2005.01006.x
  41. Skoromets AA, Guekht AB, Galanov DV, Danilenko OA, Barantsevich ER, Lebedeva AV, Belova AN, Shprakh VV, Bogdanov EI, Prokopenko SV, Khabirov FA, Spirin NN, Baliazin VA, Miakotnykh VS, Volkova LI, Gafurov BG, Mishchenko TS, Toktomushev ChT, Shiralieva RK, Musaev SK, Guseinov SG. The results of the multicenter pharmaco-epidemiological observational project on the use of mydocalm in the treatment of pain syndromes with the muscle spasm. S.S. Korsakov Journal of Neurology and Psychiatry. 2015;115(12):104-109. (In Russ.). https://doi.org/10.17116/jnevro2015115112104-109
  42. Nalamachu S, Pergolizzi J, Kaye R. Tolperisone for the Treatment of Acute Muscle Spasm of the Back: Results from the Dose-Ranging Phase 2 STAR Study (NCT03802565). Journal of Pain Research. 2020;13:3059-3069. https://doi.org/10.2147/jpr.s278857
  43. Rao R, Panghate A, Chandanwale A, Sardar I, Ghosh M, Roy M, Banerjee B, Goswami A, Kotwal PP. Clinical Comparative study: Efficacy and tolerability of tolperisone and thiocolchicoside in acute low back pain and spinal muscle spasticity. Asian Spine Journal. 2012;6(2):115.  https://doi.org/10.4184/asj.2012.6.2.115
  44. Prabhoo R, Keny S, Prabhoo T, Singh A, Rana R. A phase IV observational multi-centre, open-label study on efficacy and safety of tolperisone 150 mg in patients with painful muscle spasm associated with degenerative or inflammatory diseases of the musculoskeletal system. The Journal of the Association of Physicians of India. 2011;59:33-37.  https://pubmed.ncbi.nlm.nih.gov/21751662
  45. Kocsis P, Gajári D, Deli L, Gőcze KZ, Pozsgay Z, Tihanyi K. Effect of tolperisone on the resting brain and on evoked responses, an phMRI BOLD study. Brain Research Bulletin. 2013;99:34-40.  https://doi.org/10.1016/j.brainresbull.2013.09.008
  46. Ribi C, Vermeulen C, Hauser C. Anaphylactic reactions to tolperisone (Mydocalm). Swiss Medical Weekly. 2003;133(25-26):369-371.  https://doi.org/10.4414/smw.2003.10280
  47. Instruction for medical use of medicinal product Sirdalud, P N012947/01 of 03.08.2010. (In Russ.).
  48. Jogiraju VK, Heimbach T, Toderika Y, Taft DR. Physiologically based pharmacokinetic modeling of altered tizanidine systemic exposure by CYP1A2 modulation: Impact of drug-drug interactions and cigarette consumption. Drug Metabolism and Pharmacokinetics. 2021;37:100375. https://doi.org/10.1016/j.dmpk.2020.100375
  49. Kikuchi K, Tsukamoto K, Kikuchi H, Saito T, Mori F. Tizanidine-Induced Bradycardia Without Concomitant Medications: A Case Report. Cureus. 2024;16(5):e60581. https://doi.org/10.7759/cureus.60581
  50. Tanimura J, Hashimoto T. Case of tizanidine withdrawal showing hallucination, decorticate posture and tremor, with hypersympathetic vital signs. BMJ Case Reports. 2024;17(3):e254966. https://doi.org/10.1136/bcr-2023-254966
  51. Suárez-Lledó A, Padullés A, Lozano T, Cobo-Sacristán S, Colls M, Jódar R. Management of Tizanidine Withdrawal Syndrome: A case report. Clinical Medicine Insights Case Reports. 2018;11:117954761875802. https://doi.org/10.1177/1179547618758022
  52. Summary of product characteristics of medicinal product Reloprim, marketing authorization LP-№(000677)-(EG-RU) of 11.04.2022. (In Russ.).
  53. Spiller HA, Winter ML, Mann KV, Borys DJ, Muir S, Krenzelok EP. Five-year multicenter retrospective review of cyclobenzaprine toxicity. Journal of Emergency Medicine. 1995;13(6):781-785.  https://doi.org/10.1016/0736-4679(95)02019-5
  54. Csiba L, Zhussupova AS, Likhachev SA, Parfenov VA, Churyukanov MV, Guekht AB. A systematic review of using myorelaxants in treatment of low back pain. S.S. Korsakov Journal of Neurology and Psychiatry. 2018;118(12):100-113. (In Russ.). https://doi.org/10.17116/jnevro2018118121100
  55. LeRoy AA, Morse ML. Multiple medications and vehicle crashes: Analysis of databases. PsycEXTRA Dataset. January 2008. https://doi.org/10.1037/e495082008-001
  56. Dulin J, Kovács L, Ramm S, Horvath F, Ebeling L, Kohnen R. Evaluation of Sedative Effects of Single and Repeated Doses of 50 mg and 150 mg Tolperisone Hydrochloride. Results of a Prospective, Randomized, Double-Blind, Placebo-Controlled Trial. Pharmacopsychiatry. 1998;31(04):137-142.  https://doi.org/10.1055/s-2007-979315
  57. Caron J, Kaye R, Wessel T, Halseth A, Kay G. An assessment of the centrally acting muscle relaxant tolperisone on driving ability and cognitive effects compared to placebo and cyclobenzaprine. Journal of Clinical Pharmacy and Therapeutics. 2020;45(4):774-782.  https://doi.org/10.1111/jcpt.13165
  58. Wallace JD. Summary of combined clinical analysis of controlled clinical trials with tizanidine. Neurology. 1994;44(11 Suppl 9):S60-S69.  https://pubmed.ncbi.nlm.nih.gov/7970013
  59. De Graaf EM, Oosterveld M, Tjabbes T, Stricker BH. A case of tizanidine-induced hepatic injury. Journal of Hepatology. 1996;25(5):772-773.  https://doi.org/10.1016/s0168-8278(96)80252-2
  60. Winchell GA, King JD, Chavez-Eng CM, Constanzer ML, Korn SH. Cyclobenzaprine pharmacokinetics, including the effects of age, gender, and hepatic insufficiency. The Journal of Clinical Pharmacology. 2002;42(1):61-69.  https://doi.org/10.1177/0091270002042001007
  61. Mina D, Johansen KL, McCulloch CE, Steinman MA, Grimes BA, Ishida JH. Muscle relaxant use among hemodialysis patients: prevalence, clinical indications, and adverse outcomes. American Journal of Kidney Diseases. 2019;73(4):525-532.  https://doi.org/10.1053/j.ajkd.2018.11.008
  62. Forsah SF, Ugwendum D, Arrey Agbor DB, Ndema N, Ndemazie NB, Kankeu Tonpouwo G, Taylor AAA, Fuoching N, James-Gregory D, Amoah S, Arulthasan V, Nfonoyim J. Syncope Secondary to Concomitant Ingestion of Tizanidine and Alcohol in a Patient With Alcohol Use Disorder. Cureus. 2024;16(3):e57249. https://doi.org/10.7759/cureus.57249
  63. Chaugai S, Dickson AL, Shuey MM, Feng Q, Barker KA, Wei WQ, Luther JM, Stein CM, Chung CP. Co‐Prescription of strong CYP1A2 inhibitors and the risk of Tizanidine‐Associated hypotension: a retrospective cohort study. Clinical Pharmacology & Therapeutics. 2018;105(3):703-709.  https://doi.org/10.1002/cpt.1233
  64. Plakogiannis FA, Weidmann J, Fraser B, Kwong J, Asi D, Kumar P, Baldock M, Naamo J, Baluja R, Catanzariti R, Yeung S, Pont L, Williams K, De Rubis G, Dua K, Bukhari NI. Investigation of smoking on the antiplatelet response to clopidogrel: Unravelling the Smoker’s Paradox. Pathology — Research and Practice. 2024;257:155290. https://doi.org/10.1016/j.prp.2024.155290
  65. Hutchinson S, Marmura MJ, Calhoun A, Lucas S, Silberstein S, Peterlin BL. Use of Common Migraine Treatments in Breast‐Feeding Women: A summary of recommendations. Headache the Journal of Head and Face Pain. 2013;53(4):614-627.  https://doi.org/10.1111/head.12064
  66. Granfors M, Backman J, Laitila J, Neuvonen P. Oral contraceptives containing ethinyl estradiol and gestodene markedly increase plasma concentrations and effects of tizanidine by inhibiting cytochrome P450 1A2. Clinical Pharmacology & Therapeutics. 2005;78(4):400-411.  https://doi.org/10.1016/j.clpt.2005.06.009
  67. Killam-Worrall L, Brand R, Castro JR, Patel DS, Huynh K, Lindley B, Torres BP. Baclofen and tizanidine Adverse Effects Observed among Community-Dwelling Adults above the age of 50 years: A Systematic review. Annals of Pharmacotherapy. 2023;58(5):523-532.  https://doi.org/10.1177/10600280231193080
  68. Douglass MA. Hallucinations in an elderly patient taking recommended doses of cyclobenzaprine. Archives of Internal Medicine. 2000;160(9):1373. https://doi.org/10.1001/archinte.160.9.1373
  69. Dalmadi B, Leibinger J, Szeberényi S, Borbas T, Farkas S, Szombathelyi Z, Tihanyi K. Identification of metabolic pathways involved in the biotransformation of tolperisone by human microsomal enzymes. Drug Metabolism and Disposition. 2003;31(5):631-636.  https://doi.org/10.1124/dmd.31.5.631
  70. Cho C, Byeon JY, Kang P, Park HJ, Ko E, Mu CY, Jang CG, Lee SY, Lee YJ. Effects of CYP2C19 genetic polymorphism on the pharmacokinetics of tolperisone in healthy subjects. Archives of Pharmacal Research. 2022;46(2):111-116.  https://doi.org/10.1007/s12272-022-01423-0
  71. Sychev DA, Ashraf GM, Svistunov AA, Maksimov ML, Tarasov VV, Chubarev VN, Otdelenov VA, Denisenko NP, Barreto GE, Aliev G. The cytochrome P450 isoenzyme and some new opportunities for the prediction of negative drug interaction in vivo. Drug Design Development and Therapy. 2018;12:1147-1156. https://doi.org/10.2147/DDDT.S149069
  72. Granfors M. Fluvoxamine drastically increases concentrations and effects of tizanidine: a potentially hazardous interaction. Clinical Pharmacology & Therapeutics. 2004;75(4):331-341.  https://doi.org/10.1016/j.clpt.2003.12.005
  73. Granfors M, Backman J, Neuvonen M, Neuvonen P. Ciprofloxacin greatly increases concentrations and hypotensive effect of tizanidine by inhibiting its cytochrome P450 1A2 mediated presystemic metabolism. Clinical Pharmacology & Therapeutics. 2004;76(6):598-606.  https://doi.org/10.1016/j.clpt.2004.08.018
  74. Del Rosario ME, Weachter R, Flaker GC. Drug-induced QT prolongation and sudden death. Missouri medicine. 2010;107(1):53-58.  https://pubmed.ncbi.nlm.nih.gov/20222297
  75. Chaugai S, Dickson AL, Shuey MM, Feng Q, Barker KA, Wei WQ, Luther JM, Stein CM, Chung CP. Co‐Prescription of strong CYP1A2 inhibitors and the risk of Tizanidine‐Associated hypotension: a retrospective cohort study. Clinical Pharmacology & Therapeutics. 2018;105(3):703-709.  https://doi.org/10.1002/cpt.1233
  76. Mestres J, Seifert SA, Oprea TI. Linking pharmacology to clinical reports: cyclobenzaprine and its possible association with serotonin syndrome. Clinical Pharmacology & Therapeutics. 2011;90(5):662-665.  https://doi.org/10.1038/clpt.2011.177
  77. Keegan MT, Brown DR, Rabinstein AA. Serotonin syndrome from the interaction of cyclobenzaprine with other serotoninergic drugs. Anesthesia & Analgesia. 2006;103(6):1466-1468. https://doi.org/10.1213/01.ane.0000247699.81580.eb
  78. Sun-Edelstein C, Tepper SJ, Shapiro RE. Drug-induced serotonin syndrome: a review. Expert Opinion on Drug Safety. 2008;7(5):587-596. 
  79. Day LT, Jeanmonod RK. Serotonin syndrome in a patient taking Lexapro and Flexeril: a case report. Am J Emerg Med. 2008;26(9):1069.e1-1069.e3.  https://doi.org/10.1016/j.ajem.2008.03.028
  80. Lamberg JJ, Gordin VN. Serotonin Syndrome in a Patient with Chronic Pain Polypharmacy. Pain Medicine. 2014 Aug;15(8):1429-1431. Epub 2012 Aug 23. PMID: 22925399. https://doi.org/10.1111/j.1526-4637.2012.01468.x
  81. Yakhno NN, Kukushkin ML, Churyukanov MV, Syrovegin AV. The results of the open multicenter study «MERIDIAN» to assess the prevalence of pain syndromes in outpatient practice and therapeutic preferences of physicians. Russian Journal of Pain. 2012;3-4(36-37):10-14. (In Russ.). Accessed August 26, 2024. https://www.elibrary.ru/download/elibrary_20343058_79010293.pdf
  82. Zakharova EV. Teoreticheskie kontseptsii i metody issledovaniya komplaensa i priverzhennosti lecheniyu. Teoreticheskaya i eksperimental’naya psikhologiya. 2019;12(3):96-110. (In Russ.).
  83. Eisen SA. The effect of prescribed daily dose frequency on patient medication compliance. Archives of Internal Medicine. 1990;150(9):1881. https://doi.org/10.1001/archinte.1990.00390200073014
  84. Coleman CI, Limone B, Sobieraj DM, Lee S, Roberts, MS, Kaur R, Alam T. Dosing frequency and medication adherence in chronic disease. Journal of Managed Care Pharmacy. 2012;18(7):527-539.  https://doi.org/10.18553/jmcp.2012.18.7.527
  85. Parfenov VA, Bogdanov EI, Laskov VB, Makarov NS, Pizova NV, Salina EA, Chefranova ZhYu, Chichanovskaya LV. Multicenter, randomized, double-blind study of the efficacy and safety of prolonged release tolperisone hydrochloride 450 mg (Mydocalm® Long, once daily) and tolperisone hydrochloride 150 mg (three times daily) for acute non-specific lower back pain. Nevrologiya, nejropsikhiatriya, psikhosomatika. 2021;13(6):14-22. (In Russ.).
  86. Alvarez PA, Pahissa J. QT alterations in psychopharmacology: proven candidates and suspects. Current Drug Safety. 2010;5(1):97-104.  https://doi.org/10.2174/157488610789869265
  87. Momo K, Doki K, Hosono H, Homma M, Kohda Y. Drug interaction of tizanidine and fluvoxamine. Clinical Pharmacology & Therapeutics. 2004;76(5):509-510.  https://doi.org/10.1016/j.clpt.2004.08.003
  88. Rosenlicht NZ, Riley-Lazo KP. Interactions of cyclobenzaprine and tricyclic antidepressants. The Journal of Clinical Psychiatry. 2005;66(1):134-135.  https://doi.org/10.4088/jcp.v66n0118b
Contact the author
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.

Email Confirmation

An email was sent to test@gmail.com with a confirmation link. Follow the link from the letter to complete the registration on the site.

Email Confirmation

Contact us
If you have any questions, complaints or suggestions, please use this feedback form.
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.
Submit Application

You can become an author of one of our magazines, send a request and we will consider it in during the day.

Name
Phone
E-mail
Message
Login
Registration
E-mail
Password
Forgot Password?

Log in to the site using your account in one of the services

Password recovery
E-mail
Login
Register

We use cооkies to improve the performance of the site. By staying on our site, you agree to the terms of use of cооkies. To view our Privacy and Cookie Policy, please. click here.