Muscle Spasms and More: 7 Tizanidine Uses

Tizanidine (Zanaflex) is a muscle relaxer that’s FDA approved for muscle spasticity in adults. But it also has other “off-label” uses. In fact, research suggests up to 40% of prescriptions of tizanidine are for off-label uses. This is when a prescriber recommends a medication for a condition it’s not FDA approved to treat, but real-world research or experience suggests a benefit.

Below, we look at seven tizanidine uses and what the research says about how well it works for each of these conditions. Plus, we’ll cover tizanidine side effects to help you weigh its risks and benefits.

1. Spasticity

Spasticity is the only FDA-approved use for tizanidine. In early clinical trials, tizanidine was tested in people with spasticity caused by multiple sclerosis (MS) and spinal cord injury (SCI). These studies found that tizanidine improved muscle stiffness more than placebo (a pill with no medication in it).

Today, tizanidine is considered a second-choice medication for spasticity from MS and SCI. Typically, another muscle relaxer called baclofen is tried first. But research shows tizanidine may work as well as baclofen to relax muscles.

Tizanidine may also be used for muscle spasticity as a result of stroke, brain injuries, and more. Tizanidine is also prescribed off-label for children with cerebral palsy.

2. Back pain

Lower back pain can be acute (sudden pain that lasts days to weeks) or chronic (lasting 3 months or more). Chronic low back pain is the leading cause of disability worldwide.

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Muscle relaxers like tizanidine may be prescribed off-label for lower back pain. But they’re typically not first-choice options. Acute back pain is usually first treated with non-medication approaches, like heat or massage. When medications are needed, over-the-counter (OTC) pain relievers are preferred. Nonsteroidal anti-inflammatory drugs (NSAID), such as ibuprofen (Advil, Motrin) are a first-choice option. Muscle relaxers may also be recommended. 

Evidence suggests that NSAIDs may be preferred to muscle relaxers because they're more effective and cause fewer side effects. Still, some research shows that short-term tizanidine use is effective at treating acute back pain. However, combining tizanidine with an NSAID may be most effective. But this combination is more likely to cause side effects, including drowsiness. For some people, drowsiness may be a welcome effect if they’re having trouble sleeping at night because of the pain.

If your prescriber recommends tizanidine, they’ll often say to take it for a short period of time only, up to 2 to 3 weeks at most. If your pain becomes chronic, muscle relaxers aren’t typically first-choice options. So talk to your prescriber if your pain continues longer than expected.

3. Migraines and headaches

Some research has looked at tizanidine to prevent and treat migraines and headaches. For example, a study of 200 people found that tizanidine (combined with other medications) helped reduce daily headaches in people with migraines, migraine headaches, and tension-type headaches. However, the research is mixed. Another study showed tizanidine wasn’t effective at relieving tension-type headaches.

Based on the research, it’s unclear how effective tizanidine is for headaches and migraines. And it’s not a first-choice option. But still, if muscle tightness or spasms are causing migraines, tizanidine may help by relaxing the muscles in your head and neck.

4. Rebound headaches

When migraine medications are used more often, or in larger amounts than recommended, rebound headaches can occur. These are a type of headache that occurs due to overuse of your headache medication. Your risk is higher if you use migraine medications, such as sumatriptan (Imitrex), ibuprofen, or acetaminophen (Tylenol), for more than 10 days a month for over 3 months.

EXPERT PICKS: WHAT TO READ NEXT

• Tizanidine side effects: Tizanidine has risks to consider, including drowsiness, dizziness, and withdrawal if you suddenly stop taking it. 

• Non-opioid options for pain: Learn about other non-opioid medications and alternative approaches for managing chronic pain, including back pain and headaches.

• Tizanidine for preventing migraines: Learn how tizanidine helped three people manage their migraines so they can also maintain their busy lives.

If you experience rebound headaches, talk to your prescriber. They’ll work with you to help minimize how often you’re needing migraine medications. This might mean changing medications, but another option to treating rebound headaches is to combine an NSAID with tizanidine short-term.

5. Fibromyalgia

Fibromyalgia is a chronic condition causing widespread pain and fatigue. Treatment for fibromyalgia involves talk therapy, gentle exercise, and stress reduction. Some people also need medication. 

FDA-approved options for fibromyalgia include pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella). Muscle relaxants might help too if your fibromyalgia is causing muscle spasms. Though cyclobenzaprine (Flexeril) is the muscle relaxer that’s more commonly used, there’s some older research that suggests tizanidine might improve fibromyalgia symptoms, too.

6. Myofascial pain

Myofascial pain is a type of pain that affects muscles and the surrounding fascia (thin layer of connective tissues). If you’ve experienced back or neck pain, there’s a good chance you’ve had myofascial pain.

NSAIDs are typically tried first for myofascial pain. But if they don’t work on their own, your prescriber might recommend that you also take a muscle relaxer like baclofen or tizanidine. However, there’s only limited research that shows tizanidine may be effective for myofascial pain. 

As with other types of pain, there are non-medication approaches for managing myofascial pain. Gentle fascia stretching can help keep your connective tissues relaxed and flexible, which may lessen or prevent fascia pain. Deep tissue massage may also help relax the areas causing pain.

Is tizanidine a controlled substance?

Tizanidine isn’t a controlled substance. And it’s not an opioid, either. In fact, muscle relaxants have been increasingly prescribed in recent years as healthcare professionals try to avoid opioids due to the risk of dependence and misuse.

Still, muscle relaxants like tizanidine can cause drowsiness and dizziness. This can make accidents and falls more likely, especially if you combine them with other sedatives. For example, taking tizanidine with opioids can also raise the risk of an opioid overdose.

What are the most common tizanidine side effects?

Dry mouth, drowsiness, dizziness — tizanidine is known for causing anticholinergic side effects like these. Constipation and weakness are also common. Older adults, in particular, are more likely to be bothered by these side effects. However, tizanidine may actually be a good option in older adults, as it tends to cause these side effects to a lesser degree than some other muscle relaxers.

Still, older adults may need to start on a lower tizanidine dose to minimize side effects. Alternatively, your prescriber may suggest a safer treatment for your condition. Some experts recommend that adults 65 years and older avoid muscle relaxers altogether due to the risk of falls and confusion.

What are more serious tizanidine warnings?

Liver damage is a rare tizanidine side effect. Let your prescriber know if you notice dark urine, abdominal swelling or pain, and yellowing of your eyes after starting tizanidine. They can check your liver health by ordering a blood test. 

Hallucinations are another rare tizanidine side effect. Older adults are more likely to have confusion and mental health changes from tizanidine. This risk, however, may be less likely with tizanidine than with baclofen.

Common side effects, such as feeling dizzy and drowsy, can turn serious. It can be especially dangerous if you’re drinking alcohol or you take other medications that cause drowsiness, such as opioids or benzodiazepines. To stay safe while taking tizanidine, here are some points to keep in mind:

• Until you know how tizanidine affects you, avoid driving or other activities requiring alertness. Muscle relaxers raise the risk of car accidents.

• Avoid drinking alcohol while tizanidine is in your system. It can take up to 12 hours or more for tizanidine to leave your body.

• Ask your prescriber or pharmacist if tizanidine interacts with your other medications and OTC products. If possible, it’s best to avoid tizanidine with other medications that make you dizzy or drowsy.

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Written by:

Daphne Berryhill, RPh

Daphne Berryhill, RPh, has two decades of experience as a clinical pharmacist. She spent most of her career in the Chicago area practicing in-home infusion.

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:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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