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.
TIZANIDINE: MUSCLE RELAXANT IN CP
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.
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
Adverse reactions may be more likely and more severe in older (aged above
60 years) patients.
caution is needed for driving or doing hazardous work, as the drug may
cause sedation leading to risk of accidents.
Avoid alcohol when taking the drug due to risk of additive sedation
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.
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
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
Loss of consciousness and respiratory depression have been noted thus far
in limited experience with the drug. Other symptoms may occur.
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:
High blood pressure medicine
Birth control pills
Phenytoin for epilepsy
Kidney or Liver disease: Increased chances of side effects due to delay in
getting rid of the drug from the body.
More common: Fever; loss of appetite; nausea and/or vomiting;
nervousness; pain or burning while urinating; sores on the skin; tingling,
burning, or prickling sensations; yellow eyes or skin
Less common: Black, tarry stools; bloody vomit; blurred vision;
chills or sore throat; coldness; convulsions (seizures); cough; dry, puffy
skin; eye pain; fainting; irregular heartbeat; kidney stones; seeing things
that are not there; unusual tiredness or weakness; weight gain
Self limiting side effects not usually requiring medication:
Anxiety; back pain; constipation; depression; diarrhea; difficulty in
speaking; dizziness or lightheadedness, especially when getting up from a
lying or sitting position; drowsiness; dry mouth; heartburn; increased
sweating; increased muscle spasms or tone; muscle weakness; pain or burning
in throat; runny nose; skin rash; sleepiness; stomach pain; uncontrolled
movements of the body. Besides these, less common side effects may include
difficulty swallowing; dry skin; joint or muscle pain or stiffness; loss of
hair; migraine headache; mood changes; neck pain; swelling of feet or lower
legs; swollen area that feels warm and tender; trembling or shaking; unusual
feeling of well-being; weight loss
A recent report
The use of tizanidine in cerebral palsy
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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