Posted 12/10/2010 12:55 AM (GMT 0)
Hi shaw. Sorry to hear about your flexeril issues, as it is a potent muscle relaxant, but a lot of people (including myself) seem to experience some uncomfortable side effects. For me they aren't severe enough to stop using the medication, but enough to request other medications if it has to be used on a long term basis.
Flexeril is one of the better working medications to control muscle spasms, and IMHO can be used for anxiety with twitchiness, RLS, and even as a sleep aid. However, there are atleast a few other options but each has atleast some effects or dependancy risk (almost all muscle relaxants have a risk of withdraw and dependancy is usually unnoticed, but non of them are truly "addictive" if used as prescribed.)
Valium is a great alternative to flexeril because it has excellent muscle relaxant properties, and its anti anxiety properties add to this effect. Most doctors are will to prescribe Valium on an as needed basis at low doses (2mgs or 5mg). The risk of dependancy on low dose valium really only develops after months of use, so its ideal for as needed or short term round the clock use, but not so much for long term round the clock use. If you use it continuously for more than 90 days, you should be slowly withdrawn as serious withdraw reactions can occur. Its main mechanism of action is CNS relaxation through GABA A potentiation. Its side effects mostly certer around drowsiness, but some individuals would concur that these drowsiness effects are less than those of flexeril. Dry Mouth is a side effect still but in my personal experience, dry mouth and drowsiness were less pronounced with valium. The hangover effect and prolonged sleep effect also seems to be less prevelant with this medication. To me personally, valium is kind of like flexeril lite. Flexeril causes dehydration and Valium increases urinary dispensation which can cause dry mouth, but with valium you should be able to avoid the dry mouth by drinking extra water. It has a relatively long duration of action (8 hours) but has a long half life, so you can skip a single dose from time to time if you are on it around the clock.
Baclofen is considered very effective in some cases (I will explain below) and has a mechanism of action that is somewhat similiar to Valium. It potentiates GABA B, and has little effect on GABA A. It was thought to be less dependancy producing than valium, but like valium it can cause withdraw. Baclofen works best when used in conjunction with a "pump" system. This is because the body does not absorb Baclofen very well. Powerful relaxant but poorly absorbed in the pill route. Its an alternative atleast worth looking into though as drowsiness, dry mouth, disorientation seem to be minimal.
Zanaflex works relatively well but has a shorter duration. It also drops blood pressure. It can interfere with certain medications that are norephedrine related, and it can potentiate certain pain medications in a positive way, so be sure you tell your doctor ALL medications you are taking if you decide to request this.
Soma is an excellent muscle relxant but it has a short duration of action. When used with certain medications, it can significantly boost the effects of those medication, so it has a potential to be addictive when used in certain combinations, ESPECIALLY Hydrocodone. At the same time, for severe pain that cannot be treated by hydrocodone and a weaker muscle relxant, this can be an excellent combination if your doctor is willing. Its worth asking about as I was on this for a few months and did not experience any significant hangovers, dry mouth, or really any bad side effects. It should be withdrawn slowly if used longer than 90 days.
Robaxin is a poor muscle relaxant, but is often favored by some doctors since it carries a lower risk of dependancy and withdraw. It works by depressing the CNS system but its effects are about 1/3 those of soma. It might be an option if your spasms aren't severe and like soma has almost no side effects with the exception that its harder on the stomach.
Lorazapam can be used for muscle spasm pain with sleeplessness but it has a very potent knock out effect, has a high risk for hangover, and can cause amnesic like effects (forgetting the last hour before you went to bed).
Klonopin is becoming a more popular choice for muscle spasm control, especially when the patient has sleeplessness. Its not as potent as lorazapam and has a much longer duration of action (12 full hours so only 2 a day would be needed, and as it has some residule relxant properties from 12 to 36 hours, some might be able to get by with just a single one daily, and if used for round the clock dosing, a single dose can be skipped from time to time, just don't skip 2 or 3 doses as severe withdraw symptoms can manifest after 36 hours). It does have some hangover effect risk, but it is less pronouced than lorazapam. Both should be withdraw slowly, especially lorazapam due to the fact that it clears the system quickly. Both valium and klonopin can be withdraw from relatively easily due to their long half life, but lorazapam is harder to tapper of. Again, little risk for addiction but higher risk for dependancy and withdraw when compared to valium and klonopin. Both Klonopin and lorazapam increase urinary dispensation, and to a higher degree than valium does but drinking a full glass of water with the dosage minimizes the dry mouth effect.
I hope this helps. Please only take what I said with a grain of salt as I'm neither a doctor or pharmacist. I'm just someone who has lived with chronic pain for a long time and did his research :)