CENTRALLY ACTING SKELETAL MUSCLE RELAXANTS Generic name: tizanidine Brand name: Apo-Tizanidine (CAN), Zanaflex Drug classes:

antispasmodic and sympatholytic (centrally acting) Pregnancy Drug Category C Primary actions: centrally acting alpha2-agonist; antispasmodic effect thought to be a result of indirect depression of polsynaptic reflexes by blocking the excitatory actions of spinal interneurons. Indications: Acute and intermittent management of increased muscle tone associated with spaticity. Contraindications and cautions: Contraindicated with hypersensitivity to tizanidine, concomitant use of

fluroxamine, ciprofloxacin. Use cautiously with hepatic or renal impairment, hypotension, pregnancy, lactation. Available forms:Tablets-2, 4 mg; capsules-2, 4, 6 mg Dosages: Adults: 4mg/day PO, increased in 2- to 4-mg increments as needed over 2-4 wk. Usual maintenance dose is 8 mg PO every 6-8 hr; maximum dose, 36 mg/day in divided doses. Pediatric patients: safety and efficasy not established. Patients with renal impairment: use lower doses, monitor response. Pharmacokinetics: route oral onset 30-60 min peak 1-2 hr duration 3-6 hr

Metabolism: hepatic, T1/2: 2.7-4.2 hr Distribution: crosses placenta, may enter breast milk Excretion: urine

Adverse effect: CNS: drowsiness, sedation, dizziness, asthma, headache, hallucinations, somnolence CV: hypotension, orthostatic hypotension, bradycardia GI: dry mouth, constipation, anorexia, malaise, nausea, vomiting, parotid pain, paroritis, mild transient abnormalities in LFTs Interactions: Drug-drug: Potential risk of increased depression with alcohol, baclofen, ather CNS depressants. Possible increased effects with hormonal contraceptives, monitor patient and decrease tizanidine dose. Do not use in combination with other alpha2-adrenergic agonists.

Nursing considerations Assessment: History: hypersensitivity to tizanidine, clonidine; hepatic or renal impairment; hypotension; pregnancy, lactation. Physical: mucous membranes- color, lesions, orientation, affect; P, BP, orthostatic BP; perfusion; liver evaluation; LFTs, renal function tests. Interventions: Administer drug evry 6-8 hr around the clock for best effects. Adjust drug dosage slowly, which helps decreased side effects. Continue all supportive measures used for spinal cord- injured or neurologically damaged patients. Provide sugarless lozenges or ice chips, as appropriate, if dry mouth or altered taste occurs. Established safety precautions if CNS or hypotensive changes occur (use side rails, accompany patient when ambulating). Attempt to lower dose if side effects become severe or intolerable.

Teaching points: Take this drug exactly as prescribed. It is important that you not miss doses. Consult your health care provider to determine a schedule that will not interfere with rest. Continue all other supportive measures for your condition. You may experience these side effects: drowsiness, dizziness, light-headedness, headache, weakness (use caution while driving or performing tasks that require alertness or physical dexterity); dry mouth (suck on sugarless lozenges or ice chips); GI upset (eat frequent small meals); dizziness, light-headedness when changing position (rise slowly, use caution when transferring. Report changes in urine or stool, severe dizziness or passing out, changes in vision, difficulty swallowing.