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Zanaflex should be used with caution in patients with any hepatic impairment.. Zanaflex is a central alpha-2-adrenergic agonist indicated for the management of spasticity. Withdrawal symptoms are more likely to occur in cases where high doses are used, especially for prolonged periods, or with concomitant use of narcotics. [ The influence of hepatic impairment on the pharmacokinetics of tizanidine has not been evaluated. A statistically significant reduction of the Ashworth score for Zanaflex compared to placebo was detected at 1, 2 and 3 hours after treatment. [ Zanaflex use has been associated with hallucinations. Tell your doctor if you need to use any of these other medicines together with Zanaflex.Avoid drinking alcohol. Adverse reactions such as hypotension, bradycardia, or excessive drowsiness can occur when Zanaflex is taken with other CYP1A2 inhibitors, such as zileuton, fluoroquinolones other than ciprofloxacin (which is contraindicated), antiarrythmics (amiodarone, mexiletine, propafenone), cimetidine, famotidine, oral contraceptives, acyclovir, and ticlopidine ). Retrospective analysis of pharmacokinetic data, however, following single and multiple dose administration of 4 mg Zanaflex showed that gender had no effect on the pharmacokinetics of tizanidine.Pharmacokinetic differences due to race have not been studied.The interaction between Zanaflex and either fluvoxamine or ciprofloxacin is most likely due to inhibition of CYP1A2 by fluvoxamine or ciprofloxacin. Administration of the capsule contents sprinkled on applesauce was not bioequivalent to administration of an intact capsule under fasting conditions. Two studies were conducted in patients with multiple sclerosis and one in patients with spinal cord injury. Cold or allergy medicine, narcotic pain medicine, sleeping pills, other muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by tizanidine. Flexeril (cyclobenzaprine) and Zanaflex (tizanidine hydrochloride) are muscle relaxants used to treat muscle tightness and cramping (spasm) caused by acute, painful musculoskeletal conditions. The greatest reduction in muscle tone was 1 to 2 hours after treatment. Each ZANAFLEX 4 mg tablet contains 4 mg of tizanidine (as hydrochloride) as the active ingredient. Respiratory depression is another common feature of tizanidine overdose.Should overdose occur, basic steps to ensure the adequacy of an airway and the monitoring of cardiovascular and respiratory systems should be undertaken. Withdrawal symptoms included hypertension, tachycardia, hypertonia, tremor, and anxiety. Monitor patients who take Zanaflex with another CNS depressant for symptoms of excess sedation. It can increase some of the side effects of tizanidine.You should not use Zanaflex if you are allergic to tizanidine, or if:you also take the antidepressant fluvoxamine (Luvox); oryou also take the antibiotic ciprofloxacin (Cipro).To make sure Zanaflex is safe for you, tell your doctor if you have:It is not known whether Zanaflex will harm an unborn baby. In all, 140 patients received placebo, 8 mg or 16 mg of Zanaflex.Response was assessed by physical examination; muscle tone was rated on a 5 point scale (Ashworth score), with a score of 0 used to describe normal muscle tone. In these patients, during titration, the individual doses should be reduced. For the most recent information concerning the management of overdose, contact a poison control center.Tizanidine is a central alpha-2-adrenergic receptor agonist and presumably reduces spasticity by increasing presynaptic inhibition of motor neurons.

These changes may result in increased adverse events, or delayed or more rapid onset of activity, depending upon the nature of the switch. Administration of the capsule contents on applesauce resulted in a 15%–20% increase in C Tizanidine has linear pharmacokinetics over the doses studied in clinical development (1–20 mg). Because tizanidine is extensively metabolized in the liver, hepatic impairment would be expected to have significant effects on pharmacokinetics of tizanidine.

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