Tizanidine Dosages: Your GoodRx Guide

Tizanidine (Zanaflex) is part of a group of medications called muscle relaxers. It’s FDA approved to treat spasticity, which occurs when your muscles contract for too long. This leads to muscle stiffness and tightness. People with certain conditions, like cerebral palsy and multiple sclerosis, often experience spasticity. 

Tizanidine is also prescribed off-label to help with other types of pain. If you’re prescribed tizanidine, you’ll want to be sure you understand how to take it. Taking the correct tizanidine dosage helps maximize the medication’s effectiveness, while minimizing its potential side effects.

Tizanidine isn’t approved for use in children, so we’ll only review adult dosages in this article.

What’s the typical tizanidine dosage for adults?

Tizanidine is often taken on an as-needed basis. The typical starting tizanidine dosage is 2 mg every 6 to 8 hours. Generally, you shouldn’t take more than 3 doses per day.

Depending on how you respond to the medication, your prescriber may increase your doses by 2 mg to 4 mg every few days. The maximum recommended single dose is 16 mg. The maximum dose within a 24-hour period is 36 mg.

You can take tizanidine with or without food, but it’s best to be consistent. So, if you decide to take tizanidine with food, be sure to take every dose with food. This helps keep the levels of medication in your blood steady.

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Tizanidine is available as both tablets and capsules, which come in 2 mg and 4 mg doses. A 6 mg capsule is also available. The capsules can be swallowed whole or opened up and sprinkled onto applesauce. It’s possible to switch between the capsules and tablets, but you’ll want to talk to your prescriber about it first. Tizanidine products aren’t always interchangeable, meaning that a 2 mg capsule isn’t always the same as a 2 mg tablet.

Are there any dosage adjustments for medical conditions?

You may need to take a lower dosage of tizanidine if you have kidney or liver problems, or if you take certain medications that can interact with tizanidine. You may also need a lower dosage if you’re older, since you may be more likely to experience side effects like dry mouth, tiredness, and low energy.

Adjustments for people with kidney problems

The kidneys play a major role in helping your body get rid of tizanidine through your urine. So if you have kidney problems, tizanidine can build up in your body. Let your prescriber know if you have kidney problems before starting treatment with tizanidine. They may start you at a lower dosage.

Adjustments for people with liver problems

Tizanidine is metabolized (broken down) in the liver. So if you have liver problems, the levels of tizanidine in your blood may be higher than normal. If so, your prescriber may recommend a lower dosage. They may also monitor your liver function more closely with liver function tests, a type of blood test.

In rare cases, tizanidine can also cause liver damage. So let your prescriber know if you have existing liver problems. It’s possible they’ll want you to avoid tizanidine entirely.

Adjustments for people taking interacting medications

Certain medications can increase tizanidine levels in the body. These medications include:

• Ciprofloxacin (Cipro)

• Fluvoxamine (Luvox)

• Acyclovir (Zovirax)

• Amiodarone (Pacerone)

• Famotidine (Pepcid AC, Zantac 360)

• Birth control pills like norethindrone acetate / ethinyl estradiol (Junel 1.5/30, Junel 1/20, Loestrin Fe 1/20)

If possible, it’s best to avoid combining tizanidine with these medications. And keep in mind that this isn’t a complete list of medications that can interact with tizanidine. Giving your prescriber and pharmacist a current list of your medications can help them accurately screen for interactions.

If you need to take a medication that can increase tizanidine levels, your prescriber may recommend a lower tizanidine dosage and monitor you for side effects like tiredness, low blood pressure, and dizziness.

How do you stop taking tizanidine?

The best way to stop taking tizanidine depends on your dosage and how long you’ve been taking the medication. If you’ve been taking 20 mg or more per day for 9 weeks or more, it’s not a good idea to stop tizanidine treatment abruptly. This could lead to withdrawal symptoms such as a fast heartbeat, increased blood pressure, and worsening muscle stiffness.

Regardless of how long you’ve been taking tizanidine, talk to your prescriber before stopping treatment. If they think you need to taper off the medication, they may gradually decrease your doses by 2 mg to 4 mg. This helps lower the risk of withdrawal symptoms.

What happens if you miss a dose of tizanidine?

If you miss a dose of tizanidine and you’re experiencing muscle pain symptoms, you can take the medication as soon as you remember. Keep in mind, though, that you’ll want to take your missed dose in the same way you usually take your doses — with or without food. 

If it’s close to your next scheduled tizanidine dose by the time you realize you missed one, don’t double up. Just wait until your next dose and continue with your usual tizanidine schedule.

Keep in mind that you may not need to take tizanidine if you’re not experiencing muscle pain symptoms. But talk to your prescriber about whether it’s OK to take tizanidine on an as-needed basis.

What should you do if you take too much tizanidine?

If you take too much tizanidine, you may experience increased side effects. These side effects might include dry mouth, dizziness, and tiredness. Whether you experience severe effects depends on how much of the medication you took. Regardless, you should contact your prescriber’s office immediately if you took extra tizanidine. Alternatively, you can contact Poison Control at 1-800-222-1222.

Taking large amounts of tizanidine can cause dangerous side effects such as slowed heart rate, confusion, and low blood pressure. In severe cases, it can lead to coma and death. If you’re experiencing symptoms that feel severe, like extreme fatigue or confusion, seek emergency care immediately.

How to save on tizanidine

There are ways to save on tizanidine, which is available as a lower-cost generic medication. GoodRx may be able to help you save over 80% off the average retail price of generic tizanidine tablets. At certain pharmacies, the price may be as low as $9.00 with a free GoodRx coupon.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Alex Brewer, PharmD, MBA

Alex Brewer, PharmD, MBA, is a licensed pharmacist specializing in chronic disease and health and wellness. Upon completing his residency, he worked in the managed care field, conducting medication therapy management and adherence counseling sessions with Medicaid, Medicare, and private insurance patients, before transitioning to a career in medical writing.

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