Tizanidine

To reduce the risk of experiencing side effects, the recommended initial adult dose of tizanidine is 2 mg up to 3 times daily. The dose is then increased gradually in 2 mg to 4 mg steps until an effective dose is reached. The most common maintenance dose is 8 mg taken up to 3 times daily (every 6 to 8 hours). Do not take more than 36 mg of tizanidine within a 24-hour period.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without talking to your doctor. Always take tizanidine exactly as prescribed by your doctor.

Tizanidine can be taken with or without meals, however taking tizanidine with food may increase the side effects of Tizanidine. Always take tizanidine the same way, either with food or on an empty stomach.

Stopping the medication suddenly may cause an increase in blood pressure, rapid heart rate and muscle spasms. Talk to your doctor to find a safe way to stop taking the medication.

It is important to take Tizanidine exactly as prescribed by your doctor. If you miss a dose of this medicine take it as soon as possible, if you remember within an hour or so of the missed dose. If you do not remember until later, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store tizanidine away from heat and direct light and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause dryness of the mouth; it may cause drowsiness or dizziness - use caution when getting up from a lying or sitting position and use caution if driving; it may cause unusual tiredness; it may lower your blood pressure, which could cause weakness and/or dizziness. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

Apo-Tizanidine is no longer being manufactured for sale in Canada. For brands that may still be available, search under tizanidine. This article is being kept available for reference purposes only. If you are using Tizanidine, speak with your doctor or pharmacist for information about your treatment options.

Do not take Tizanidine if you:

• are allergic to tizanidine or any ingredients of Tizanidine
• require muscle spasticity for balance and movement
• are taking certain medications, such as:
  • ciprofloxacin
  • Fluvoxamine

There may be an interaction between tizanidine and any of the following:

• Abiraterone
• Acetaminophen
• acyclovir
• alcohol
• Aldesleukin
• Aliskiren
• alpha agonists (e.g., Clonidine, methyldopa)
• alpha blockers (e.g., Alfuzosin, Doxazosin, Tamsulosin)
• amifostine
• angiotensin converting enzyme (ACE) inhibitors (e.g., Captopril, Lisinopril, Ramipril)
• antiarrhythmics (e.g., Amiodarone, Disopyramide, dofetilide, Dronedarone, Flecainide, Mexiletine, procainamide, quinidine)
• anti-psychotics (e.g., Chlorpromazine, Clozapine, Haloperidol, Olanzapine, Quetiapine, Risperidone)
• antihistamines (e.g,. cetirizine, doxylamine, Diphenhydramine, Hydroxyzine, Loratadine)
• barbiturates (e.g., butalbital, pentobarbital Phenobarbital)
• benzodiazepines (e.g., Alprazolam, Diazepam, Lorazepam)
• beta-blockers (e.g., Carvedilol, Propranolol, Timolol)
• birth control pills
• brimonidine
• Buprenorphine
• Buspirone
• caffeine
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Verapamil, Nifedipine)
• cannabis
• chloral hydrate
• chloroquine
• Cimetidine
• Deferasirox
• Degarelix
• Digoxin
• diuretics (water pills; e.g., Furosemide, Hydrochlorothiazide, Spironolactone)
• Domperidone
• Donepezil
• efavirenz
• estrogens (ethinyl Estradiol, conjugated estrogen)
• Famotidine
• Fingolimod
• Galantamine
• Gemfibrozil
• general anesthetics (medications used to put people to sleep before surgery)
• Guanfacine
• Hydralazine
• Ivabradine
• kava kava
• ketoconazole
• Lanreotide
• lidocaine
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• magnesium sulfate
• Methadone
• methoxsalen
• mifepristone
• Mirtazapine
• muscle relaxants (e.g., Baclofen, Cyclobenzaprine, methocarbamol, orphenadrine)
• Nabilone
• narcotic pain relievers (e.g., Codeine, Fentanyl, Morphine, Oxycodone)
• nitrates (e.g., Nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)
• Obinutuzumab
• Octreotide
• Olopatadine
• Pasireotide
• phosphodiesterase 5 inhibitors (e.g., Sildenafil, Tadalafil, Vardenafil)
• Pramipexole
• Primaquine
• protein kinase inhibitors (e.g., Ceritinib, Lapatinib, Pazopanib, Sunitinib, Vemurafenib)
• quinine
• "quinolone" antibiotics (e.g., ciprofloxacin, Norfloxacin, Ofloxacin)
• rilpivirine
• Rivastigmine
• Ropinirole
• Rotigotine
• saquinavir
• scopolamine
• seizure medications (e.g., Clobazam,Levetiracetam, phenobarbital, Phenytoin, primidone, Topiramate, Valproic acid, zonisamide)
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Fluoxetine, Paroxetine, Sertraline)
• serotonin antagonists (anti-emetic medications; e.g., Dolasetron, Granisetron, Ondansetron)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., Desvenlafaxine, Duloxetine, Venlafaxine)
• Tapentadol
• Tetrabenazine
• thalidomide
• Ticlopidine
• Tramadol
• Tranylcypromine
• Trazodone
• tricyclic antidepressants (e.g., Amitriptyline, Desipramine)
• Voriconazole
• Zolpidem
• Zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Tizanidine. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Tizanidine.

Birth control: Women taking birth control pills may need a lower dose of tizanidine to achieve a good effect. Birth control pills prevent tizanidine from leaving the body readily and may cause tizanidine to build up in the body leading to side effects.

Drowsiness/reduced alertness: Tizanidine may cause drowsiness and severe dizziness. Do not drive, operate machinery, or perform other potentially hazardous tasks until you have determined how Tizanidine affects you.

Heart rhythm: Tizanidine can cause changes to the normal rhythm of the heart, including an irregular heartbeat called QT prolongation. QT prolongation is a serious life-threatening condition that can cause fainting, seizures, and sudden death. If you are at risk for heart rhythm problems (e.g., people with heart failure, Angina, low potassium or magnesium levels), discuss with your doctor how Tizanidine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Tizanidine, and whether any special monitoring is needed.

Kidney function: People with decreased kidney function are more likely to experience side effects at lower doses. If you have Kidney Disease or decreased kidney function, discuss with your doctor how Tizanidine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Tizanidine, and whether any special monitoring is needed.

Liver function: Tizanidine is removed from the body by the liver and may cause liver problems. Decreased liver function or liver disease can cause Tizanidine to build up in the body, causing side effects. If you have liver disease or decreased liver function, discuss with your doctor how Tizanidine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Tizanidine, and whether any special monitoring is needed.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Low blood pressure: Symptoms of severe lowering of blood pressure, such as weakness or dizziness, particularly when rising suddenly from a sitting or lying position, may occur. People who are prone to low blood pressure (e.g., those taking diuretics) should be cautious when using Tizanidine. This effect may happen before the dose of medication is enough to reduce the muscle spasticity. Starting Tizanidine at a very low dose and gradually increasing the daily dose helps to reduce the effect of rapidly dropping blood pressure.

Mental health: Tizanidine can cause hallucinations (e.g., seeing or hearing things that are not really there). People with a history of mental health concerns, such as psychosis or Schizophrenia are more likely to experience this effect. If you have a history of mental health issues, discuss with your doctor how Tizanidine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Tizanidine, and whether any special monitoring is needed.

Stopping the medication: Stopping Tizanidine suddenly can cause increased muscle spasms, an increase in blood pressure, or a rapid heart rate. Talk to your doctor before stopping Tizanidine.

Pregnancy: Tizanidine has not been studied for use by pregnant women. In some animal studies, tizanidine caused birth defects and other pregnancy problems. Tizanidine should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking Tizanidine, contact your doctor immediately.

Breast-feeding: It is not known if tizanidine passes into breast milk. If you are a breast-feeding mother and are taking Tizanidine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using tizanidine has not been established for children less than 18 years of age.

Seniors: Tizanidine is cleared from the body at a slower rate in older adults. This can result in an increase in the number and severity of side effects. The doctor will take this into consideration when determining the dose you should be taking.

This medication is typically used every 6 to 8 hours. However, your pharmacist may have suggested a different schedule that is more appropriate for you. Generally, it is used only as needed. Important: Follow the instructions on the label. Do not use more of this product, or more often, than prescribed. This medication may be taken with or without food. Consuming alcohol may intensify the effect of this product. Limit alcohol consumption to occasional small quantities.