TizanidineTizanidine Hydrochloride

About Tizanidine

Tizanidine acts on central alpha-2 adrenergic receptors and presumably reduces spasticity by increasing inhibition of motor neurons. It is labeled for spasticity in adults; its effect was shown in two studies of people with multiple sclerosis or spinal cord injury, and safety and effectiveness in children have not been established. Treatment starts at 2 mg every 6 to 8 hours as needed, up to three doses in 24 hours, and can rise by 2 to 4 mg per dose every 1 to 4 days, to a maximum of 36 mg a day; single doses above 16 mg have not been studied. Liver enzymes are checked before treatment and a month after the maximum dose is reached. People with severe kidney impairment (creatinine clearance below 25 mL/min) or with liver impairment use lower individual doses, and older adults need caution because they clear it more slowly.

Tizanidine can lower blood pressure and cause fainting, especially on standing up from lying down, so it needs care with blood pressure medicines and is not recommended with other alpha-2 agonists such as clonidine. It can injure the liver, cause sleepiness that interferes with daily activities, and cause hallucinations or psychotic-like symptoms, and severe allergic reactions such as anaphylaxis and angioedema have been reported. It must not be taken with strong CYP1A2 blockers, such as fluvoxamine and ciprofloxacin, or by anyone allergic to it. Stopping suddenly can cause rebound high blood pressure, a fast heart rate and increased muscle tone, especially after high doses (20 to 28 mg a day) for nine weeks or more or with opioids, so the dose is lowered by 2 to 4 mg a day. Dry mouth, sleepiness, weakness and dizziness are the most common side effects, and a slow heartbeat has been seen.

Capsules and tablets are equivalent on an empty stomach but not with food: food raises the tablets’ peak level, while the capsules’ peak falls and comes 2 to 3 hours later. So each dose is taken the same way, always with food or always without, and patients are told not to switch between tablets and capsules; a capsule opened onto applesauce gives higher levels than one swallowed whole while fasting. Ontralfy, a 2 mg per 5 mL oral solution approved in December 2024, gave exposure comparable to tablets with or without food and to capsules taken with food. Birth control pills slow its clearance and are not recommended with it, and alcohol raises its levels. Human data in pregnancy and breastfeeding are lacking; in animals it harmed fetal development and passed into milk. It is not a controlled substance.

Taking Tizanidine

How to take it

Every 6 to 8 hours as needed, no more than three doses in 24 hours. Take each dose the same way, always with food or always without, and stay with the form you were given unless the prescriber changes it. Stand up slowly, and do not stop it suddenly.

If you miss a dose

If you take it on a regular schedule, take the missed dose when you remember, unless the next dose is almost due; then skip it. Do not take a double dose.

Storage

At room temperature in the original, tightly closed container, away from heat and moisture (not in the bathroom), out of reach of children. Use a take-back program rather than flushing unused medicine.

Interactions to know about

Never with fluvoxamine or ciprofloxacin. Other CYP1A2 blockers, such as zileuton, amiodarone, mexiletine, propafenone, verapamil, cimetidine, famotidine, acyclovir, ticlopidine and birth control pills, are avoided. Blood pressure medicines and other alpha-2 agonists add to low blood pressure, and alcohol, benzodiazepines, opioids and tricyclic antidepressants add to sedation.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Tizanidine differs from pharmacy to pharmacy

Generic tablets and capsules each have many makers, but a pharmacist can substitute only within the same form, since the two are not equivalent when taken with food. A prescription that names Zanaflex and blocks substitution is priced as a brand, as is Ontralfy, which has no generic and comes in 473 mL bottles. The count depends on how each dose is built from the 2, 4 and 6 mg strengths, up to three doses a day.

Ways to pay less for Tizanidine without insurance

• Ask for a generic of the form you take, and check that the prescription does not name Zanaflex only.
• If you were prescribed capsules or the oral solution, ask the prescriber whether tablets would suit you; switching needs a new prescription.
• Once your daily dose is settled, ask for a ninety-day supply.
• Compare more than one pharmacy, and ask whether tizanidine is on a flat-price generic list.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Tizanidine

1. 1.Is my prescription for tablets or capsules, and should I take it with food or without?
2. 2.Do any of my medicines, such as an antibiotic, birth control pills, an acid reducer, or a heart rhythm or blood pressure medicine, interact with it?
3. 3.When should my liver tests be done?
4. 4.How should my dose be lowered if I need to stop?

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