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ATC code M03 Muscle relaxants is a therapeutic subgroup of the Anatomical Therapeutic Chemical Classification System, a system of alphanumeric codes developed by the World Health Organization (WHO) for the classification of drugs and other medical products.
The clinical effectiveness of methocarbamol compared to other muscle relaxants is not well known. [12] One trial of methocarbamol versus cyclobenzaprine, a well-studied muscle relaxant, in those with localized muscle spasm found there were no significant differences in their effects on muscle spasm, limitation of motion, or limitation of daily activities.
Acute use (1–3 days) yields a potency about 1.5× stronger than that of morphine and chronic use (7 days+) yields a potency about 2.5 to 5× that of morphine. Similarly, the effect of tramadol increases after consecutive dosing due to the accumulation of its active metabolite and an increase of the oral bioavailability in chronic use.
Other common spasmolytic agents include: methocarbamol, carisoprodol, chlorzoxazone, cyclobenzaprine, gabapentin, metaxalone, and orphenadrine. Thiocolchicoside is a muscle relaxant with anti-inflammatory and analgesic effects and an unknown mechanism of action.
Effectiveness has not been clearly shown for metaxalone, methocarbamol, chlorzoxazone, baclofen, or dantrolene. [7] Applicable conditions include acute back [8] or neck pain, or pain after an injury. Long-term use of muscle relaxants in such cases is poorly supported. [8]
Cyclobenzaprine, sold under several brand names including, historically, Flexeril, is a muscle relaxer used for muscle spasms from musculoskeletal conditions of sudden onset. [5] It is not useful in cerebral palsy. [5] It is taken by mouth. [5] Common side effects include headache, feeling tired, dizziness, and dry mouth. [5]
Side effects of thiocolchicoside can include nausea, allergy and vasovagal reactions. [15] Liver injury, pancreatitis, seizures, blood cell disorders, severe cutaneous disorders, rhabdomyolysis, and reproductive disorders have all been recorded in the French and European pharmacovigilance databases and in the periodic updates that the companies concerned submit to regulatory agencies.
Baclofen, sold under the brand name Lioresal among others, is a medication used to treat muscle spasticity, such as from a spinal cord injury or multiple sclerosis. [ 8 ] [ 9 ] It may also be used for hiccups and muscle spasms near the end of life, [ 9 ] and off-label to treat alcohol use disorder [ 10 ] [ 11 ] or opioid withdrawal symptoms. [ 12 ]