Tizanidine: Things you should know

Tizanidine: Things you should know

Tizanidine is a muscle relaxant that can be used orally. This medication possesses antispasmodic and antispastic properties, which means that it works on the skeletal muscles and central nervous system to relieve muscle tightness while also reducing muscle spasms and spasm-like symptoms. Multiple sclerosis, stroke, and spinal cord injuries are among the conditions that can result in spasticity. A doctor may prescribe tizanidine to help manage the symptoms of spasticity.

Even while most people accept tizanidine well and find that it can be helpful in relieving their symptoms, muscle relaxants can occasionally cause negative effects. As a result, it is critical that patients adhere to the dose recommendations made by their doctors.

General recommendation from physicians is that patients begin with 2 milligrammes (mg) per dose and gradually increase this quantity until they achieve adequate relief. Individuals may take the drug three times per day — with a gap of 6–8 hours between doses — if necessary, but the total daily dose should not exceed 36 mg.

Dry mouth, drowsiness, fatigue, and dizziness are some of the most common side effects of tizanidine use. The danger of low blood pressure and liver damage are the two most serious side effects connected with the medication.

In this post, we will go over tizanidine in further detail, covering its applications, dosage, side effects, and drug interactions, among other things.



Tizanidine is a member of a class of medications known as central alpha-2 adrenergic receptor agonists. It is a muscle relaxant with a short duration of action that doctors routinely prescribe to assist control muscle stiffness.

In order to work, it must increase the inhibition of motor neurones in the brain, which are the nerve cells responsible for sending information to the muscles in order for the muscles to contract. Despite the fact that the medication has no direct effect on muscles, its suppression of motor neurones causes the muscles to relax in an indirect manner.


Tizanidine may be prescribed by doctors to treat muscle spasms that arise as a result of the following conditions:

  • multiple sclerosis
  • stroke
  • spinal cord injury
  • brain injury
  • musculoskeletal injury


Tizanidine is available in the form of 2- or 4-mg tablets and 2-, 4-, or 6-mg capsules. According to the Food and Drug Administration (FDA), a single dose of 8 mg can provide relief from spasticity for up to several hours. The effects are at their peak 1–2 hours after the dose, and they subside after around 3–6 hours.

Because of the possibility of dose-related adverse effects, people will often begin with a lower dose of 2 or 4 mg to begin with. Once the dose has been established, a doctor can gradually increase it in increments of 2–4 mg every 1–4 days until the desired effect is achieved with a manageable quantity of adverse effects. People can repeat the dose at 6- to 8-hour intervals, but they should never take more than three doses in a 24-hour period, for a total of 36 mg.

It is also important to note that doctors should exercise caution when prescribing tizanidine to patients who have liver or kidney impairments because these conditions can slow the rate of elimination and cause the medicine to have a longer duration of action in the body.

Side effects

The most common side effects include:

  • dry mouth
  • dizziness
  • urinary tract infections
  • constipation
  • sleepiness and lethargy
  • weakness and lack of energy
  • vomiting
  • speech disorders
  • urinary frequency
  • blurred vision
  • nervousness
  • flu syndrome, which is a cluster of symptoms similar to those of the flu
  • abnormal liver function test results
  • inflammation of the mucous membranes of the nose
  • sore throat
  • involuntary movements

Drug interactions

The use of tizanidine in conjunction with fluvoxamine (Luvox), a drug for obsessive-compulsive disorder, or ciprofloxacin (Cipro), an antibiotic, according to a study report published in 2021 advises against side effects. Low blood pressure or issues with involuntary movements are possible side effects of either of these drug combos.

The use of tizanidine in conjunction with other CYP1A2 inhibitors, such as birth control pills, is not recommended because of the possibility of drug interactions. CYP1A2 is an enzyme that aids in the metabolization of medicines. If the CYP1A2 enzyme is inhibited, the body will be unable to eliminate the medication as efficiently as it should, increasing the probability of unpleasant responses.

According to the available evidence, tizanidine may interfere with the effects of alcohol, other central nervous system depressants (such as opioids), and other central alpha-2 adrenergic agonists.

Other cautionary tales

The following are some of the risks related with tizanidine:

  • Injury to the liver: Clinical investigations have revealed that approximately 5% of patients who use tizanidine experience elevations in liver enzymes that are more than three times the upper limit of what is considered normal. The enzyme levels revert to normal in the vast majority of cases once the medicine is stopped. However, there have been isolated reports of symptoms of liver damage, as well as a few accounts of deaths as a result of this condition.
  • Low blood pressure: Doctors should be on the lookout for signs and symptoms of this disorder, which include lightheadedness, dizziness, a slow heartbeat, and fainting, among other things.
  • Sedation: According to clinical research, tizanidine causes sleepiness in 48 percent of those who take it. It is expected that substantial sedation will be required in 10% of instances.
  • Hallucinations: People who took tizanidine reported hallucinations or delusions in two clinical studies, according to the results of the studies. Hallucinations are the perception of something that is not physically present, such as seeing, hearing, tasting, smelling, or experiencing it. A delusion is a false belief in something that does not exist in reality.

Best way to take tizanidine

When taking tizanidine, the time of day and the food you eat can make a difference. In addition, if it becomes necessary to cease the medication, the manner in which a person does so is critical to its success.

As a result of the brief duration of action, people should only take tizanidine when a reduction in spasticity is absolutely necessary. It is recommended that if a person accidentally forgets to take a dose, they skip it if it is almost time for the following dose. In the event that you do not wait 6–8 hours between dosages, you may get an overdose.

Food has a complex effect on tizanidine, and the effect can alter depending on whether a person is taking a tablet or a capsule of the medication. In the case of tablets, food might enhance some elements of absorption, but food can impair absorption in the case of capsules. As a result, there may be a greater possibility of unpleasant events occuring as well as more rapid or delayed effects of the medications.

Because of this, it is critical that individuals follow their doctor’s recommendations on how to take the medication, including whether it should be taken with or without a meal.

If someone wants to stop taking tizanidine, they should do it gradually, especially if they are taking high doses of the medication. Reducing the dosage gradually can help to reduce the risk of withdrawal as well as other undesirable effects such as high blood pressure and rapid heartbeat, among others. A doctor will discuss the best method for weaning yourself off of the medication.

Several other considerations

Additional concerns may include the need for storage, insurance, and the monitoring of potential harmful consequences.


According to the FDA, the recommended storage temperature is 77°F (25°C), but temperatures between 59°F (15°C) and 86°F (30°C) are acceptable for a short period of time. A child-resistant cap should be used on the container in which the medication is dispensing.


Tizanidine is covered by the majority of private insurers and Medicare programmes, though the copay and deductible differ from policy to policy. Anecdotal evidence says that the average cost of a 30-count prescription of 4-mg tablets is close to $20 if the patient does not have insurance.


Tizanidine should be administered under the supervision of a doctor, who should check on the patient’s kidney and liver function before increasing the dose. Typically, this monitoring will include the following activities:

  • measuring creatinine, which is a waste product that indicates how well the kidneys are working
  • Liver function tests, which assess the levels of liver enzymes in the blood and can be used to detect probable liver disease
  • keeping an eye out for signs of low blood pressure.


Doctors may administer tizanidine to patients suffering from illnesses such as multiple sclerosis in order to alleviate muscle stiffness in the affected area. Motor neurones are inhibited by the medication, allowing the muscles to relax as a result. Tablets and capsules are both available in different dosage forms.

Because tizanidine may produce adverse effects, it is critical that people take the medication in the dosage that their doctor has prescribed. The medication is available in three different dosage strengths: 2, 4, and 6 mg.

Taking three doses a day is permissible, but they should be spaced six to eight hours apart and the total dosage over a 24-hour period should not exceed 36 mg. People should also inform their doctor of any other drugs that they are currently taking and enquire as to whether tizanidine should be taken with or without food in order to be effective.