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     Zanaflex
     

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Drug Uses

Zanaflex a muscle relaxant is used to help relax certain muscles in your body. It relieves the spasms and increased muscle tone caused by medical problems such as multiple sclerosis or spinal injury. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

How Taken

Zanaflex comes as a tablet to take it orally. It usually is taken two or three times a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take Zanaflex exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Warnings/Precautions

Before taking this medication, tell your doctor if you have liver disease, have kidney disease, have low blood pressure or you are on medication to treat high blood pressure; or you are taking birth control pills. You may not be able to take Zanaflex, or you may require a lower dose or special monitoring during treatment if you have any of the conditions listed above. Zanaflex is in the FDA pregnancy C. This means that it is not known whether Zanaflex will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant. It is not known whether Zanaflex passes into breast milk. Do not take Zanaflex without first talking to your doctor if you are breast-feeding a baby.

Missed Dose

If you take several doses per day, take the missed dose as soon as you remember it and take any remaining doses for that day at evenly spaced intervals. However, if you remember a missed dose when it is almost time for your next scheduled dose, skip the missed dose. Do not take a double dose to make up for a missed one.

Possible Side Effects

Side effects from Zanaflex can occur. Tell your doctor if any of these symptoms are severe or do not go away: dizziness, upset stomach, vomiting, tingling sensation in the arms, legs, hands, and feet, dry mouth, increased muscle spasms. If you experience either of the following symptoms, call your doctor immediately: yellowing of the skin or eyes, unexplained flu-like symptoms.

Storage

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

Overdose

Seek emergency medical attention. Symptoms of a Zanaflex overdose are not well known but include unconsciousness and irregular breathing.

More Information

Use caution when driving, operating machinery, or performing other hazardous activities. Zanaflex may cause drowsiness and dizziness. If you experience drowsiness or dizziness, avoid these activities. Dizziness is most likely to occur when you rise from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall. Use caution with alcohol, other muscle relaxants, sleep or anxiety medicines, and pain medicines. These drugs may increase drowsiness and dizziness while you are taking Zanaflex. Do not take any other medicine during treatment with Zanaflex without first talking to your doctor or pharmacist.

Disclaimer

This drug information is for your information purposes only, it is not intended that this information covers all uses, directions, drug interactions, precautions, or adverse effects of your medication. This is only general information, and should not be relied on for any purpose. It should not be construed as containing specific instructions for any particular patient. We disclaim all responsibility for the accuracy and reliability of this information, and/or any consequences arising from the use of this information, including damage or adverse consequences to persons or property, however such damages or consequences arise. No warranty, either expressed or implied, is made in regards to this information.




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RANCHO MIRAGE, CALIF. -- An antispasticity drug, tizanidine, appeared to be effective in treating analgesic rebound headache, chronic tension-type headache, and related pain disorders in several retrospective or open-label prospective trials. Response to treatment with tizanidine (Zanaflex) for chronic daily headache did not seem to differ in patients based on whether or not they had musculoskeletal symptoms such as spasticity, Dr. Timothy, R. Smith said at a meeting sponsored by the Diamond Headache Clinic. He conducted a retrospective review of 53 patients at his clinic treated for chronic daily headache that was thought to be caused by analgesic overuse. The patients were given tizanidine (2 mg to start, titrated up as tolerated), together with a once-daily long-acting NSAID (naproxen) or COX-2 inhibitor (Celecoxib), while eliminating other analgesics. After 12 weeks, 38 patients (71%) stopped having chronic daily headache and reverted to intermittent headaches, said Dr. Smith of Ryan Headache Center, Chesterfield, Mo. A separate retrospective review of charts and headache diaries for 62 patients with chronic daily headache found no association between response to tizanidine and the presence of musculoskeletal symptoms, suggesting that the drug's effects on headache are due to factors other than muscle relaxation, he added. The drug reduced the frequency of headache by at least half in 46 (74%) of patients, 34 (74%) of whom had muscle spasticity at baseline. Muscle spasticity was pre sent in 11 (69%) of nonresponders, a rate that was not significantly different from the responders group, Dr. Smith reported. "The presence of musculoskeletal symptoms could not predict a clinical response to tizanidine," he said. Elan Pharmaceuticals, the maker of tizanidine, funded the studies. Dr. Smith has served on the speaker's bureau for Elan Pharmaceuticals and for eight other drug companies. A separate review of poster presentations on tizanidine at previous medical meetings found four small uncontrolled studies suggesting benefit from treating certain pain syndromes with the drug, Dr. Gary E. Ruoff reported in a separate poster presentation at the meeting. His review also was funded by Elan Pharmaceuticals. Dr. Ruoff serves on the speaker's list for Elan and five other drug companies. One open-label trial by Dr. Smith and his associates used 3.6 mg tizanidine daily in 70 patients with analgesic rebound headache who were transitioning to decreased NSAID use, Dr. Ruoff reported. After 12 weeks, 46 patients (66%) discontinued their chronic NSAID use without worsening headaches. Three patients (4%) experienced treatment-limiting adverse effects, said Dr. Ruoff, who is in practice in Kalamazoo, Mich. A second open-label trial of 220 patients with recalci- trant chronic tension-type headache who were titrated up to a mean dose of 26 mg tizanidine daily found a response after 10 weeks in 150 patients (68%), reducing headache frequency by a mean of 73%. In this study, 13 patients (6%) experienced treatment-limited adverse effects. A third open-label trial of 4-8 mg tizanidine daily in 26 patients with fibromyalgia found decreases on average in the number of tender points, improvements in global assessment scores, Fibromyalgia Impact Questionnaire scores, and visual analog scores after 8 weeks. In a retrospective chart review, 20 patients who had traumatically induced myofascial pain were given 2-6 mg tizanidine three times daily. Improvements in pain symptoms--including headache--were noted in 14 of the patients (70%) after 4-6 weeks. The drug was well tolerated. Tizanidine is an imidazoline derivative, an [[alpha].sub.2]-agonist that is structurally related to clonidine. Many patients with chronic daily headache are thought to have a down regulation of norepinephrine receptors caused by excessive release of norepinephrine from the locus ceruleus. Tizanidine has been shown to decrease norepinephrine release in the central nervous system. This effect may help restore the homeostatic balance of norepinephrine, thereby reducing patients' perception of pain, Dr. Ruoff speculated.

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