Which Muscle Relaxers Are Best for Neck and Back Pain?
Muscle relaxers are medications that help your muscles unwind, relieving muscle stiffness and pain. Learn the names of common muscle relaxers and how they work.
tizanidine
Used for Spasticity
Used for Spasticity
Tizanidine, also known by its brand name Zanaflex, is a muscle relaxer. It's FDA approved to treat stiff, rigid muscles in adults. This medication comes as tablets and capsules that you take by mouth. The usual dosage is taken as needed, up to 3 times a day. It has side effects like dry mouth, sleepiness, dizziness, and constipation. Tizanidine (Zanaflex) is available as a generic and brand-name medication.
What is Tizanidine (Zanaflex)?
What is Tizanidine (Zanaflex) used for?
How Tizanidine (Zanaflex) works
Tizanidine (Zanaflex) is a type of muscle relaxer called an alpha-2 agonist. It's thought to work by slowing nerve signals along your spinal cord that control muscle tone. When those signals slow down, your muscles relax.
When does Tizanidine (Zanaflex) start working?Time passed since treatment started:
Drug facts
| Common Brands | Zanaflex |
|---|---|
| Drug Class | Alpha-2 agonist |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
More on Tizanidine (Zanaflex) essentials
Side effects of Tizanidine (Zanaflex)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Dry mouth (49%)
- Sleepiness (48%)
- Weakness (41%)
- Dizziness (16%)
- Urinary tract infection (10%)
Less Common Side Effects
- Constipation
- Vomiting
- Blurry vision
- Nervousness
- Sore throat
- Runny or stuffy nose
- Infections
Tizanidine (Zanaflex) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Extreme drowsiness
- Liver damage: nausea, stomach pain, yellowing of the skin or whites of the eyes
- Hallucinations or delusions: hearing or seeing things that aren't real, believing about things that aren't true
- Allergic reaction: trouble breathing, itchy skin or rash, closing of the throat or swelling of the tongue
When do Tizanidine (Zanaflex) possible side effects begin and end?
Time passed since treatment started:
M
H
D
W
M
Sleepiness
Dizziness
Risk of allergic reaction
Seek immediate medical care if you experience this side effect.
If a line continues to the right, you'll likely keep experiencing this side effect once it starts.
More on Tizanidine (Zanaflex) side effects
The following Tizanidine (Zanaflex) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Chest pain or discomfort
fever or chills
nausea or vomiting
nervousness
pain or burning while urinating
unusual tiredness
Less common
Blurred vision
flu-like symptoms
irregular heartbeat
itching skin
right upper stomach tenderness
seeing things that are not there
shortness of breath
Incidence not known
Continuing vomiting
general feeling of tiredness or weakness
headache
light-colored stools
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Blurred vision
change in consciousness
chest pain or discomfort
confusion
decreased awareness or responsiveness
difficult or troubled breathing
dizziness, faintness or lightheadedness when getting up from a lying position
irregular, fast or slow, or shallow breathing
lightheadedness, dizziness, or fainting
loss of consciousness
pale or blue lips, fingernails, or skin
severe sleepiness
sleepiness or unusual drowsiness
slow or irregular heartbeat
sweating
unusual tiredness or weakness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Dizziness or lightheadedness, especially when getting up from a lying or sitting position
drowsiness
sleepiness
weakness
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Tizanidine (Zanaflex)
Pros
- Taken as needed (up to 3 times a day) to help relax stiff or rigid muscles
- Works within 1 to 2 hours
- Also available as capsules that can be opened and sprinkled on applesauce
- Not a controlled substance
Cons
- Can cause dizziness, sleepiness, dry mouth, and low blood pressure
- Interacts with many other medications, like birth control pills, ciprofloxacin, and opioids
- Can cause withdrawal symptoms if you lower the dose or stop suddenly
- Higher risk of side effects in older adults and people with kidney problems
Pharmacist tips for Tizanidine (Zanaflex)
- You can take tizanidine (Zanaflex) as needed for muscle spasms. Separate by at least 6 to 8 hours and take up to 3 times a day. Try to reserve taking it when it's most important or most needed for relief.
- You can take tizanidine (Zanaflex) with or without food. Try to take it the same way each time. Food can change how your body absorbs the medication. This can affect how well it works and its side effects. Taking the medication in a consistent way helps make sure it works the same for you each time.
- For the tizanidine (Zanaflex) capsules: You can swallow the capsule whole. You can also open it and sprinkle the contents on applesauce. Be sure to be consistent and always take the medication one way or the other. The amount of medication your body absorbs can be different depending on how you take it.
- Talk to your prescriber first about switching between tizanidine (Zanaflex) tablets and capsules. They might not be equal to each other on a milligram-to-milligram basis. Taking the medication with food can also change how fast or how well each form works.
- Dry mouth is a common side effect of tizanidine (Zanaflex). You can help relieve dry mouth by chewing sugar-free gum or sucking on ice chips. You can also buy saliva substitutes at the pharmacy. If dry mouth bothers you a lot, talk to your care team.
- Tizanidine (Zanaflex) can make you feel sleepy and make it harder to focus and concentrate. Avoid driving or doing anything that needs your full attention until you know how this medication affects you.
- It's best to avoid alcohol while taking tizanidine (Zanaflex). Alcohol can worsen side effects like dizziness and sleepiness. Talk to your prescriber about your drinking habits and how to take this medication in a safe way.
- Tizanidine (Zanaflex) can cause low blood pressure, especially if you stand up too fast. This can make you feel dizzy and raise your risk of falling. Try to stand up slowly and hold onto something sturdy for support.
- Don't stop taking tizanidine (Zanaflex) suddenly without talk to your prescriber first. This is especially important if you've taken it for a long time. Stopping it all at once can cause withdrawal symptoms, like high blood pressure, stiff muscles, and a fast heartbeat. If you need to stop, your prescriber can slowly lower your dose so you can stop safely.
- Tell your care team about all the medications you take and plan to take. Tizanidine (Zanaflex) can interact with some medications. Examples include birth control pills, fluvoxamine, ciprofloxacin, and opioids. These interactions can cause very low blood pressure, a slow heartbeat, and extra sleepiness. Your care team can check that your medications are safe to take together and make changes if needed.
- If you're pregnant or planning to become pregnant, talk to your prescriber. It's not clear if tizanidine (Zanaflex) is safe to take while pregnant. More research is needed to understand if it's safe. Your prescriber can help explain the risks and benefits of treatment. They can recommend a muscle relaxant that's safer to take during pregnancy.
Risks and warnings for Tizanidine (Zanaflex)
Tizanidine (Zanaflex) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Low blood pressure
- Risk factors: Age 65 years or older | Taking blood pressure medications | Taking fluvoxamine or ciprofloxacin | Standing up too quickly
Tizanidine (Zanaflex) can cause low blood pressure. This can make you feel dizzy or even faint. Your prescriber will try to lower the risk of these side effects by raising your dose slowly over time. Still, be careful when you first start the medication and any time your dose gets raised.
To lower your risk of falls, make sure to stand up slowly after sitting or lying down. Hold onto something sturdy to help yourself up. If you still feel dizzy or unsteady after some time or if your blood pressure is too low, talk to your care team.
Sleepiness
- Risk factors: People over 65 years old | Taking with alcohol or illicit drugs | Taking with fluvoxamine or ciprofloxacin | Taking other medications that cause drowsiness
Tizanidine (Zanaflex) can make you feel sleepy and make it harder to focus. This often happens in the first week of starting this medication but can also sometimes happen later.
The risk is higher for people over 65 and for those who take other medications that make you sleepy. Some medications, like fluvoxamine and ciprofloxacin, can greatly raise your risk and can't be taken with tizanidine (Zanaflex).
To stay safe, don't drive or do anything that you need to be alert for until you know how tizanidine (Zanaflex) affects you. Also don't drink alcohol while taking this medication. If these side effects bother you or make daily life hard, tell your care team.
Liver damage
- Risk factors: History of liver problems
Tizanidine (Zanaflex) can cause liver injury. If you already have liver problems, tell your prescriber so they can make sure it's safe for you. Before starting and a month after you reach your maintenance dose, your prescriber will ask you to get blood tests done. This helps check your liver health.
Watch out for nausea, stomach pain, and yellowing of the skin or whites of the eyes while taking tizanidine (Zanaflex). These can be signs of liver problems. If you notice any of these symptoms, let your care team know.
Possible hallucinations
A small number of people have had hallucinations or delusions while taking tizanidine (Zanaflex). Most people knew these experiences weren't real. But it's still important for you and your close ones to know they're possible. If you have hallucinations or delusions while taking this medication, talk to your prescriber. There might be other muscle relaxers that are better options for you.
Withdrawal symptoms if stopped suddenly
- Risk factors: Taking tizanidine (Zanaflex) for more than 9 weeks | Taking high doses of tizanidine (Zanaflex) | Also taking opioid pain medications
Don't stop taking tizanidine (Zanaflex) suddenly without talking to your prescriber first. Stopping suddenly cause withdrawal symptoms. This can include high blood pressure, a fast heartbeat, and muscle stiffness.
Withdrawal symptoms might be more likely if you stop after taking a total of 20 mg to 28 mg per day for more than 9 weeks. The risk might also be higher if you're taking tizanidine (Zanaflex) with opioid pain medications.
If you want to stop tizanidine (Zanaflex), talk to your prescriber to make sure it's the right choice for you. They can help you lower your dose slowly over time to stop safely.
Allergic reactions
Some people have had serious and sometimes life-threatening allergic reactions to tizanidine (Zanaflex). This can include hives, swelling of the tongue or throat, trouble breathing, or anaphylaxis. Call 911 right away if this happens.
Tizanidine (Zanaflex) dosage
The average cost for 30 tablets of 4mg of Tizanidine (Zanaflex) is $9.00 with a free GoodRx coupon. This is 0.00% off the average retail price of $9.00.
Typical dosage for Tizanidine (Zanaflex)
The typical starting dose is 2 mg by mouth every 6 to 8 hours, as needed (up to 3 doses a day).
If needed, your prescriber might raise your dose every few days. The maximum dose is a total of 36 mg per day.
Your dose might be different if you have liver or kidney problems.
More on Tizanidine (Zanaflex) dosage
Tizanidine (Zanaflex) reviews
GoodRx has partnered with to provide reviews on the different aspects of Tizanidine (Zanaflex).
Effectiveness
Learn more about the effectiveness of Tizanidine (Zanaflex) based on real life experiences.
Overall Rating
Based on 174 people taking this medication
2.7
Effectiveness by condition:
fibromyalgia142 reviews
3.0
multiple sclerosis16 reviews
1.9
hereditary spastic paraplegia6 reviews
1.5
insomnia5 reviews
4.5
primary lateral sclerosis5 reviews
2.5
Side effects
Learn more about the side effects others have reported while taking Tizanidine (Zanaflex).
Severity of side effects
Based on 763 people taking this medication
0%
50%
100%
Top side effects
Based on 763 people taking this medication
Sleepiness
10%
Drowsiness
10%
Dry mouth
7%
Excessive daytime sleepiness (somnolence)
4%
Fatigue
4%
Usage
Review why people stop taking this medication and how long they take it.
Reasons people stopped taking Tizanidine (Zanaflex)
Based on 551 people who have taken this medication
Did not seem to work
32%
Side effects too severe
20%
Doctor's advice
19%
Other
18%
Course of treatment ended
5%
Personal research
4%
Expense
4%
Change in health plan coverage
2%
How long people take Tizanidine (Zanaflex)
Based on 2067 people who have taken this medication
0%
50%
100%
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Interactions between Tizanidine (Zanaflex) and other drugs
Tizanidine (Zanaflex) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Tizanidine (Zanaflex). Please note that only the generic name of each medication is listed below.
More on Tizanidine (Zanaflex) interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Ciprofloxacin
- Fluvoxamine
- Viloxazine
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alfentanil
- Alprazolam
- Benzhydrocodone
- Bromazepam
- Buprenorphine
- Butorphanol
- Calcium Oxybate
- Cannabidiol
- Capmatinib
- Cetirizine
- Cimetidine
- Clozapine
- Codeine
- Deferasirox
- Desogestrel
- Dienogest
- Dihydrocodeine
- Doxylamine
- Drospirenone
- Esketamine
- Estradiol Valerate
- Ethinyl Estradiol
- Ethynodiol Diacetate
- Famotidine
- Fentanyl
- Flibanserin
- Gabapentin
- Gabapentin Enacarbil
- Gestodene
- Givosiran
- Glucagon
- Glycopyrrolate
- Glycopyrronium Tosylate
- Hydrocodone
- Hydromorphone
- Ketamine
- Lemborexant
- Levocetirizine
- Levonorgestrel
- Levorphanol
- Lofexidine
- Loxapine
- Magnesium Oxybate
- Meperidine
- Mestranol
- Methacholine
- Methadone
- Metoclopramide
- Mexiletine
- Midazolam
- Morphine
- Morphine Sulfate Liposome
- Nalbuphine
- Norethindrone
- Norfloxacin
- Norgestimate
- Norgestrel
- Ofloxacin
- Oxycodone
- Oxymorphone
- Peginterferon Alfa-2b
- Pentazocine
- Periciazine
- Pixantrone
- Ponesimod
- Potassium Oxybate
- Pregabalin
- Propafenone
- Quetiapine
- Remifentanil
- Remimazolam
- Revefenacin
- Rofecoxib
- Scopolamine
- Secretin Human
- Sodium Oxybate
- Sufentanil
- Tapentadol
- Ticlopidine
- Tiotropium
- Tramadol
- Trazodone
- Vemurafenib
- Verapamil
- Voclosporin
- Zileuton
- Zolpidem
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Tizanidine (Zanaflex) cost?
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Tizanidine (Zanaflex) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Tizanidine (Zanaflex) will not be safe for you to take.
- Taking with medications that raise the level of tizanidine (Zanaflex) in your body (strong CYP1A2 inhibitors). Examples include fluvoxamine and ciprofloxacin.
What are alternatives to Tizanidine (Zanaflex)?
There are a number of medications that your doctor can prescribe in place of Tizanidine (Zanaflex). Compare a few possible alternatives below.
News about Tizanidine (Zanaflex)
Muscle Spasms and More: 7 Tizanidine Uses
Tizanidine (Zanaflex) is a muscle relaxer primarily used to treat muscle spasms. Learn more about what tizanidine is, its different uses, and more.
Tizanidine and Alcohol: Is This Combination Risky?
Mixing tizanidine and alcohol is strongly discouraged, as combining these substances may lead to dangerous side effects. Here’s what you should know.
How Long Does Tizanidine Stay in Your System?
Learn how long tizanidine stays in your system and factors that affect its duration, as well as important things to consider when taking the muscle relaxer.
Dry mouth, Drowsiness, and Dizziness: 11 Tizanidine Side Effects You Should Know About
As with all medications, tizanidine may have side effects. Here are several common and serious side effects to watch out for as you’re taking this medication.
7 Tizanidine Interactions You Should Know About
Tizanidine (Zanaflex) may interact with ciprofloxacin, oxycodone, and Xanax. See more common tizanidine drug interactions here.
Tizanidine Dosages: Your GoodRx Guide
The recommended tizanidine dosage for adults is 2 mg every 6 to 8 hours. Learn what to do if you miss a dose of tizanidine and get info on dosage adjustments.
8 Muscle Relaxer Side Effects: Drowsiness, Dry Mouth, and More
Read on for the eight muscle relaxer side effects to know, from the common to rare, and when to reach out to your healthcare team for further guidance.
Baclofen, Botox, and More: 5 Cerebral Palsy Medications for Spasticity
Baclofen and Botox are examples of cerebral palsy medications for spasticity. They can help reduce spasticity, improve mobility, and enhance overall quality of life.
10 Medication Side Effects That Can Affect Your Mouth
Have you started taking a new medication and noticed something different about your mouth? Some medications can cause a range of mouth-related side effects, like dry tongue and burning mouth syndrome. Here are 10 common issues and medications that may cause them.
Tizanidine (Zanaflex) images
