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Last month, we reviewed the adverse drug effects (ADEs) that often can develop when providers prescribe triptans and non-steroidal anti-inflammatory drugs (NSAIDs) for pain management.(Read that article "Managing Adverse Druge Effects in Pain: Focus on Triptans and NSAIDs.") The third drug class commonly used for chronic pain conditions is muscle relaxants.There were not sufficient data of good quality to determine whether metaxalone, methocarbamol, chlorzoxazone, baclofen, or dantrolene were better than placebo for this indication.
Orphenadrine is similar in structure to diphenhydramine and its effects are thought to be due to its anticholinergic properties.It has been shown to cause anemia so it is contraindicated in patients with any type of anemia, as well as any patient with liver or kidney compromise.It is metabolized via several hepatocellular cytochrome P450 (CYP450) enzyme families; however, it has not been shown to be an inducer or an inhibitor.In some states, carisoprodol is considered a controlled substance, and several European countries have withdrawn the product.Cyclobenzaprine’s therapeutic effect is centrally mediated, and it has no direct peripheral action on the affected muscles.
It is structurally related to TCAs, and it has a similar ADE profile, including sedation, constipation, urinary retention, and dry mouth. Concomitant use of cyclobenzaprine with mono-amine oxidase inhibitors (MAOIs) may increase the potential for serotonin syndrome—fever/hypertensive crisis, seizures, and death.