A List of Skeletal muscle relaxants

A muscle relaxant is a drug that affects skeletal muscle function and decreases the muscle tone.

It may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia. The term “muscle relaxant” is used to refer to two major therapeutic groups: neuromuscular blockers and spasmolytics. Neuromuscular blockers act by interfering with transmission at the neuromuscular end plate and have no central nervous system (CNS) activity.

They are often used during surgical procedures and in intensive care and emergency medicine to cause temporary paralysis. Spasmolytics, also known as “centrally acting” muscle relaxants, are used to alleviate musculoskeletal pain and spasms and to reduce spasticity in a variety of neurological conditions. While both neuromuscular blockers and spasmolytics are often grouped together as muscle relaxants, the term is commonly used to refer to spasmolytics only.

How Skeletal Muscle Contracts

A single α-motor neuron can innervate up to 200 muscle fibers, forming a complex called motor unit (Figure 1).¹⁰ With movement, an action potential originates from the UMN in the motor cortex.⁹ This action potential depolarizes the motor neuron terminal, resulting in the opening of voltage-gated calcium (Ca²⁺) channels and the subsequent release of the neurotransmitter acetylcholine (Ach) into the synaptic cleft. In the synaptic cleft, Ach binds to nicotinic cholinergic receptors on the muscle fiber membrane, leading to an influx of sodium (Na⁺) and a discharge of potassium (K) across the muscle fiber’s membrane, which results in depolarization of the muscle fiber.¹¹ This depolarization opens voltage-gated Ca²⁺ channels on the sarcoplasmic reticulum (via ryanodine and inositol triphosphate receptors), allowing for Ca²⁺ influx into the cytoplasm of striated muscle cells.¹² The Ca²⁺ then binds to troponin C, which exposes myosin-binding sites on actin filaments. A cross-link forms between actin and myosin, leading to muscle contraction. The pumping of Ca²⁺ back into the sarcoplasmic reticulum, using adenosine triphosphate, leads to cessation of contraction.

Drug Name	Reviews	Avg. Ratings
Antiflex Generic name: orphenadrine	1 review		10
Dantrium (Pro) Generic name: dantrolene	2 reviews		10
Vanadom Generic name: carisoprodol	1 review		9.0
Soma (Pro) Generic name: carisoprodol	180 reviews		8.9
Zanaflex (Pro) Generic name: tizanidine	100 reviews		7.7
Xeomin (Pro) Generic name: incobotulinumtoxinA	2 reviews		7.5
Amrix (Pro) Generic name: cyclobenzaprine	48 reviews		7.3
Myobloc (Pro) Generic name: rimabotulinumtoxinB	3 reviews		7.2
Skelaxin (Pro) Generic name: metaxalone	82 reviews		7.2
Lioresal (Pro) Generic name: baclofen	20 reviews		6.8
Norflex (Pro) Generic name: orphenadrine	22 reviews		6.5
Flexeril (Pro) Generic name: cyclobenzaprine	197 reviews		6.3
Robaxin (Pro) Generic name: methocarbamol	63 reviews		6.3
Lorzone (Pro) Generic name: chlorzoxazone	21 reviews		6.2
Dysport (Pro) Generic name: abobotulinumtoxinA	7 reviews		6.1
Botox (Pro) Generic name: onabotulinumtoxinA	350 reviews		5.9
Parafon Forte DSC (Pro) Generic name: chlorzoxazone	3 reviews		5.9
Fexmid (Pro) Generic name: cyclobenzaprine	4 reviews		5.8
Gablofen (Pro) Generic name: baclofen	3 reviews		5.8
Robaxin-750 Generic name: methocarbamol	39 reviews		5.6
Lioresal Intrathecal Generic name: baclofen	3 reviews		5.2
Botox Cosmetic (Pro) Generic name: onabotulinumtoxinA	11 reviews		4.9
Comfort Pac with Cyclobenzaprine Generic name: cyclobenzaprine	2 reviews		4.5
Orfro Generic name: orphenadrine	0 reviews		3.0
Kemstro Generic name: baclofen	0 reviews		2.0
Dantrium Intravenous (Pro) Generic name: dantrolene	0 reviews	Add rating
Mio-Rel Generic name: orphenadrine	0 reviews	Add rating
Orphenate Generic name: orphenadrine	0 reviews	Add rating
Ozobax (Pro) Generic name: baclofen	0 reviews	Add rating
Paraflex Generic name: chlorzoxazone	0 reviews	Add rating
Remular-S Generic name: chlorzoxazone	0 reviews	Add rating
Revonto (Pro) Generic name: dantrolene	0 reviews	Add rating
Ryanodex (Pro) Generic name: dantrolene	0 reviews	Add rating

Further information

Muscle Spasms

A muscle spasm is a sudden involuntary contraction of a muscle group that involves jerking and twitching. Unlike spasticity, which is a disorder of the CNS, muscle spasms arise from a variety of peripheral musculoskeletal conditions, such as mechanical low back pain. Common skeletal muscle conditions that cause spasms include fibromyalgia, myofascial pain syndrome, and mechanical low back or neck pain.

Antispasm Agents

Most of the agents discussed here are FDA approved for adjunctive use to treat muscle spasms and pain associated with acute musculoskeletal conditions (Table 4). Health data from 2003 to 2004 revealed that cyclobenzaprine (Amrix, Fexmid, others), carisoprodol (Soma, others), and metaxalone (Metaxall, Skelaxin, others) accounted for more than 45% of medications prescribed for acute musculoskeletal pain.

Due to CNS depression, cyclobenzaprine, metaxalone, orphenadrine (Norflex, others), methocarbamol (Robaxin, others), carisoprodol, and chlorzoxazone (Lorzone, Parafon Forte DSC, others) are on the American Geriatrics Society’s Beers List of inappropriate drugs for elderly patients.

Despite this, approximately 300,000 annual prescriptions for skeletal muscle relaxants (15%) are issued to patients older than 65 years of age.

Skeletal muscle relaxants represent a diverse pharmacotherapeutic group of medications across several chemical classes that are structurally dissimilar. These agents are effective for spasticity, skeletal muscle spasms, or both.

Because of the breadth of pharmacologic mechanisms and variable pharmacokinetics, the drugs have a huge range of AEs and potential drug interactions.

Considering that these agents are most often used in the elderly and also as adjuvants for the treatment of chronic pain patients with multiple comorbidities who are likely receiving a polypharmaceutical regimen (including opioids), skeletal muscle drug selection for each patient requires careful attention to these factors.

Warnings for prescription muscle relaxants

Muscle relaxants such as carisoprodol and diazepam can be habit forming. Be sure to take your medication exactly as prescribed by your doctor.

Muscle relaxants can also cause withdrawal symptoms, such as seizures or hallucinations (sensing things that aren’t real). Do not suddenly stop taking your medication, especially if you’ve been taking it for a long time.

Also, muscle relaxants depress your central nervous system (CNS), making it hard to pay attention or stay awake. While taking a muscle relaxant, avoid activities that require mental alertness or coordination, such as driving or using heavy machinery.

You should not take muscle relaxants with:

alcohol
CNS depressant drugs, such as opioids or psychotropics
sleeping medications
herbal supplements such as St. John’s wort

Talk to your doctor about how you can safely use muscle relaxants if you:

are older than 65 years
have a mental health problem or brain disorder
have liver problems

Off-label medications for spasticity

Doctors can use certain medications to treat spasticity even when the drugs are not approved for that purpose by the U.S. Food and Drug Association (FDA). This is called off-label drug use. The following drugs are not actually muscle relaxants, but they can still help relieve symptoms of spasticity.

Benzodiazepines

Benzodiazepines are sedatives that can help relax muscles. They work by increasing the effects of certain neurotransmitters, which are chemicals that relay messages between your brain cells.

Examples of benzodiazepines include:

clonazepam (Klonopin)
lorazepam (Ativan)
alprazolam (Xanax)

Side effects of benzodiazepines can include drowsiness and problems with balance and memory. These drugs can also be habit forming.

Clonidine

Clonidine (Kapvay) is thought to work by preventing your nerves from sending pain signals to your brain or by causing a sedative effect.

Clonidine should not be used with other muscle relaxants. Taking it with similar drugs increases your risk of side effects. For instance, taking clonidine with tizanidine can cause very low blood pressure.

Clonidine is available in brand-name and generic versions.

Gabapentin

Gabapentin (Neurontin) is an anticonvulsant drug typically used to relieve seizures. It’s not fully known how gabapentin works to relieve muscle spasticity. Gabapentin is available in brand-name and generic versions.

Over-the-counter options for muscle spasms

OTC treatment is recommended as first-line therapy for muscle spasms caused by conditions such as acute lower back pain or tension headache. This means you should try OTC treatments before prescription medications.

OTC treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or a combination of both. Your doctor or pharmacist can help you choose an OTC treatment.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs work by blocking your body from making certain substances that cause inflammation and pain. NSAIDs are available in generic and brand-name versions. They’re typically sold over the counter. Stronger versions are available by prescription.

NSAIDs come as oral tablets, capsules, or suspensions. They also come as chewable tablets for children. Side effects of these drugs can include upset stomach and dizziness.

Examples of NSAIDs include:

ibuprofen (Advil, Motrin)
naproxen (Aleve)

Acetaminophen

Acetaminophen (Tylenol) is thought to work by blocking your body from making certain substances that cause pain. Acetaminophen is available in generic and brand-name versions. It comes as immediate-release and extended release oral tablets and capsules, orally disintegrating tablets, chewable tablets, and oral solutions.

The more common side effects of acetaminophen can include nausea and upset stomach.

Remedies For Muscle Pain

Muscle spasms occur when a muscle is irritated and they begin to spasm in order to protect themselves from further injury. A muscle may be used over and over for and tighten over time, but the muscle may not go into spasm until a simple movement occurs. So even the simplest task such as picking up a cup could lead to a painful muscle spasm. This can feel like tightness in the muscles of the affected area. If the initial injury is not treated the spasms will continue.

The common symptoms of stiffness, pain and swelling in joints could easily affect the surrounding muscles and give you mixed signals. Therefore , recognizing whether the pain comes from a joint or a muscle may not be an easy task for someone suffering from rheumatoid arthritis.

There are also some homes remedies to relieve muscle pain. These include treatments like putting ice packs, engaging in physical aides such as wrist, wraps or back braces that tend to minimize muscle strain via helping to hold joints and bones in correct positions.

muscle pain after exercise:

1 . Amino Acids – These are very inexpensive and can be purchased at your local vitamin store for less than $ 7 for a 15 day supply.

2 . Fish Oil – Fish oil contains Omega 3 fatty acids and will reduce inflammation in the joints as well as shorten the length of your muscle pain.

3. Aspirin – This is a tried and true pain reliever. 2-4 aspirin tablets taken a few hours after a workout will help reduce DOMS.

4. Stretching – Performing a few minutes of stretching before a workout or sports activity will not only help eliminate later muscle pain but will also help prevent serious injury.

With this cause of lower back muscle pain, the reason you feel it in this region is because the lower back muscles are the ones that do the extra work when lifting and carrying things. If you had a stronger core, however , you would feel the deep abdominal muscles engage when you properly lifted items and would be able to avoid lower back muscle pain.

The best treatment protocol is to never allow the muscle pain to start but with chronic pain patients it’s rare for any patient to have effective intervention prior to the muscle pain starting. Muscle pain is generally a secondary pain originating due to guarding, shielding, and posturing due to original pain sourcing.

To reduce muscle pain you can have regular massages, use ice packs, or resting periods. There are also certain lotions and balms that provide muscle pain relief.

Natural Remedies to Reduce Muscle Pain

1 . Get 7 to 8 hours of sleep a night.
2 . Take a green-lipped mussel oil supplement.
3. Massage a blend of essential oils of arnica, Calendula and St John’s work into the affected painful area.
4. Eat a whole food, mineral rich diet with plenty of vegetables and whole grains.

There are many causes of joint pains making you restless and bothersome. Joint pain is not the disease itself but the symptom of mild to serious disease. Fever can be the cause of generalized joint pains. It can be caused due to sprain or ligament injury, cartilage tearing, dislocations and sports injuries such as tennis elbow and swimmers shoulder in the case of injuries with swelling and redness around the injured part.

Another way to control the pain is by simply applying ice on the affected muscle. Cold temperature can relax the muscle and make the swelling controllable. It can manage the pain quickly because the ice will reduce the inflammation of the muscle. Use cold compress method within the first 72 hours of muscle pain.

There are several herbal oils that can have a wonderful effect on muscle pains. Some of the oils that are prevalently used for muscle pain massages include castor oil and olive oil. The massage must be done by an expert, always moving the hands in the direction of the pain. The idea is to allow the muscle wastes to enter the circulatory stream of the body and then go out with the other wastes. Done properly, a single massage session should be great for muscle pain relief.

Cures:

Chronic pain in the upper back that is not relieved by any of the above treatments can be a sign of a more serious condition. If this is the case, consult a doctor. You might be suffering from scoliosis (misalignment of the spine), which can be corrected surgically. If you have seriously injured your back muscles, your doctor might also try ultrasound treatments for a deep muscle massage.

What is the most popular muscle relaxant?

Some of the popular and commonly prescribed muscle relaxants are briefly described below. These are prescription drugs and are typically only used when other medications like non-steroidal anti-inflammatory drugs (NSAIDs), have not provided sufficient pain relief from muscle spasms.

BACLOFEN

Brand names: Lioresal, Lioresal Double Strength.

Best for: Muscle spasms and tightness caused by spinal cord injuries and multiple sclerosis.

Dosage forms: Tablet, solution, suspension, packet.

Common side effects: Drowsiness, headache, nausea, vomiting, confusion, and muscle weakness.

CARISOPRODOL

Brand names: Soma, Vanadom.

Best for: Painful muscle and bone conditions like acute low back pain or neck pain.

Dosage forms: Tablet.

Common side effects: Drowsiness, dizziness, headache.

Note: Carisoprodol (Soma) tablet is a Schedule IV controlled substance with abuse potential (it can be habit-forming).

METHOCARBAMOL

Brand names: Robaxin, Robaxin-750.

Best for: Painful muscle and bone conditions like back pain.

Dosage forms: Tablet, injection.

Common side effects: Dizziness, headache, blurred vision, flushing, nausea.

TIZANIDINE

Brand names: Zanaflex, Comfort Pac with Tizanidine.

Best for: Muscle cramping and tightness caused by multiple sclerosis and spinal cord injury.

Dosage forms: Tablet, capsule.

Common side effects: Fatigue, dizziness, dry mouth, constipation.

CHLORZOXAZONE

Brand names: Lorzone, Remular-S, Parafon Forte DSC.

Best for: Painful musculoskeletal conditions.

Dosage forms: Tablet.

Common side effects: Dizziness, drowsiness, nausea.

CYCLOBENZAPRINE

Brand names: Flexeril, Amrix, Fexmid, FusePaq Tabradol.

Best for: Muscle spasms, pain, stiffness, and discomfort caused by strains and sprains.

Dosage forms: Tablet, extended-release capsule, suspension.

Common side effects: Dizziness, drowsiness, dry mouth, blurred vision.

METAXALONE

Brand names: Skelaxin.

Best for: Painful bone and muscle conditions like sprains, strains, and muscle injuries.

Dosage forms: Tablet, injection.

Common side effects: Dizziness, drowsiness, nausea, vomiting.

ORPHENADRINE

Brand names: Norflex.

Best for: Pain, discomfort, stiffness (increased muscle tone) caused by strains, sprains, and muscle injuries, shaking or trembling in Parkinson’s disease.

Dosage forms: Extended-release tablet.

Common side effects: Dry mouth, dizziness, heartburn, nausea, vomiting, difficulty urinating.

DANTROLENE

Brand names: Dantrium.

Best for: Muscle cramps and tightness associated with conditions like multiple sclerosis, cerebral palsy, stroke, and spinal cord injuries.

Dosage forms: Capsule, injection.

Common side effects: Drowsiness, light sensitivity.