Summary: Tizanidine is a muscle relaxant drug that is being used to provide useful anti-spasmodic activity in muscles to help persons with Cerebral Palsy achieve a more useful activity from their limbs. This section is a simplified account of that given in USP DI, and is included here only as a guide and with no commercial interest. Last revised January 21, 2007.



 Principal Uses

Tizanidine (avaiable as SIRDALUD and a number of combinations with pain-killers) is a drug that relaxes the voluntary muscles of the body. It is used to relieve the muscle spasticity and cramping associated with multiple sclerosis, spinal cord injury, bone and joint diseases causing reflex muscle spasm, and now, muscle spasm in cerebral palsy.

Mode of action

Tizanidine is a short-acting drug that temporarily inhibits nerve activity that causes spasticity. Because of the risk of side effects, it should be taken only at times of the day when reduced spasticity is most important.

Dosage guidance

Initial dose: 4 mg, every 6 to 8 hours. This may be increased as needed in 2 to 4 mg increments to 8 mg every 6 to 8 hours (not exceeding 3 doses in 24 hours), until a satisfactory therapeutic effect is achieved. Maximum dose is 36 mg a day.
Onset of Effect: Within 1 hour.
Duration of Action: Up to 6 hours.
Dietary Advice: It can be taken with or between meals. Dry mouth is a common complaint with such drugs; maintain adequate fluid intake and suck on ice chips if desired.
Missed dose : Take it as soon as you remember. If it is near the time for the next dose, skip the missed dose and resume your regular dosage schedule. Do not double the next dose.
How long to take? : The decision to stop taking the drug should be made by your doctor. Those taking it for a long period should see the doctor regularly for tests and examinations as required.

How to store the drug

Store in a tightly sealed container away from heat and direct light. Precautions


In some animal studies, large doses of tizanidine have been shown to cause problems. Human studies have not been done. This drug should be used during pregnancy only if clearly needed. Consult your doctor for advice.

Breast Feeding

Tizanidine may pass into breast milk and sedate the child. Consult your doctor for advice before breast feeding.

Infants and Children

There is no specific information about the use of tizanidine in infants and children.

Special Concerns

Tizanidine is a newly introduced medication, and it is possible that side effects not found in early studies may occur with widespread use. Patients should be alert for the signs of significantly lowered blood pressure (dizziness, faintness, disorientation). In clinical trials of tizanidine, a small number of patients experienced hallucinations that continued after treatment was stopped. Dose-related eye damage (retinal degeneration and corneal opacities) was detected in some animal studies but has not been seen in human clinical trials.

Overdose Symptoms:

Loss of consciousness and respiratory depression have been noted thus far in limited experience with the drug. Other symptoms may occur.

Drug Interactions

Tizanidine may have a variety of drug interactions with many drugs, requiring adjustment of drug dosage to suit an individual patient as per clinical findings. These particularly relate to the following:

Side Effects

A recent report

The use of tizanidine in cerebral palsy in children

Zh Nevrol Psikhiatr Im S S Korsakova 1999;99(10):30-3

Brin IL; Kurenkov AL; Gotlib VI

30 diplegic children (mean age 11.3 +/- 2.8 years old) with severe form of cerebral palsy received tizanidine monotherapy during 2-6 weeks (1 mg for children under 10 years old and 2 mg for older children, 3 times daily). Positive effects were determined in motor, autonomic and mental (emotional) spheres. Tizanidine was also very effective in patients after orthopedic-surgical treatment. Electroneuromyographic analysis showed the decrease of the synergic tonic activity, as well as the improvement of the supraspinal influences and the segmental interaction. Thus, the small doses of tizanidine are effective without side effects in children with cerebral palsy.


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