Which Muscle Relaxant do you prefer to prescribe?

[lobelsteve]

Remember that, with the exception of baclofen, none of them have direct effect on the muscles themselves.

Even baclofens main location of action is CNS and spinal cord.

There is no good science for muscle relaxation as these meds don't really relax muscles.

Baclofen. Tizanidine. Dantrolene.
Anti spasticity. So they do relax muscles. Just not for folks without cns lesions.

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[DODOCSS]

little flexy qhs

 

[Snowmen96]

Baclofen. Tizanidine. Dantrolene.
Anti spasticity. So they do relax muscles. Just not for folks without cns lesions.

To be fair, Dantrolene does act peripherally and by directly relaxing the muscle (if it doesn't relax your liver first).

 

[Baron Samedi]

To be fair, Dantrolene does act peripherally and by directly relaxing the muscle (if it doesn't relax your liver first).

Dantrolene doesn't have a role in pain management. It's for non ambulatory patients with spasticity.

 

[lobelsteve]

Dantrolene doesn't have a role in pain management. It's for non ambulatory patients with spasticity.

Some pain docs are physiatrists so we treat spasticity as well.

 

[au bon pain]

Unless a patient specifically requests tiz/flex/robax/baclo based on prior experience w/no AEs, I've started prescribing mag oxide bid.

Extremely safe, no sedation and have had some surprisingly decent success with it.

 

[oreosandsake]

Baclofen. Tizanidine. Dantrolene.
Anti spasticity. So they do relax muscles. Just not for folks without cns lesions.

Unless a patient specifically requests tiz/flex/robax/baclo based on prior experience w/no AEs, I've started prescribing mag oxide bid.

Extremely safe, no sedation and have had some surprisingly decent success with it.

What’s the dose?

 

[lobelsteve]

What’s the dose?

Baclofen 10 bid titrating to 20 qid for spasticity.
Dantrolene 25 tid (dogma to avoid in elderly females due to liver tox)
Zanaflex 8mg (2pills of 4mg) tid (only tolerated by 10% of patients at this dose due to sedation)

 

[Ducttape]

Some pain docs are physiatrists so we treat spasticity as well.

yes but you are treating spasticity and not using them as muscle relaxants for a general population.

say dantrolene to an anesthesiologist and the first question will be "do i need to call the MH hotline?"

 

[au bon pain]

What’s the dose?

400mg mag oxide qd for 5-7d

Then if no SEs (very seldom but some have diarrhea) 400bid thereafter

Tell pts to take bid for 2-3 weeks before they decide it’s not working