Buy Zanaflex Online

What is Zanaflex?

Zanaflex is a short-acting muscle relaxer. It works by blocking nerve impulses (pain sensations) that are sent to your brain.

Zanaflex is used to treat spasticity by temporarily relaxing muscle tone.

Zanaflex may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about Zanaflex?

Zanaflex is a short-acting medication that should be taken only for daily activities that require relief from muscle spasticity.

Do not take Zanaflex if you are also taking the antidepressant fluvoxamine (Luvox), or the antibiotic ciprofloxacin (Cipro). Do not use Zanaflex at a time when muscle tone is needed to assure safe balance and movement for certain activities. In some situations, it may endanger your physical safety to be in a state of reduced muscle tone.

Switching between Zanaflex tablets and capsules, or changing the way you take it with regard to eating, can cause an increase in side effects or a decrease in therapeutic effect. Follow your doctor's instructions carefully. After making any changes in how you take Zanaflex, contact your doctor if you notice any change in how well the medicine works or if it causes increased side effects.

Do not take more than three doses (36 mg) of Zanaflex in a 24-hour period. Too much of this medication can damage your liver. Cold or allergy medicine, narcotic pain medicine, sleeping pills, other muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by Zanaflex. Tell your doctor if you need to use any of these other medicines together with Zanaflex. Avoid drinking alcohol. It can increase some of the side effects of Zanaflex.

What should I discuss with my healthcare provider before taking Zanaflex?

Do not use Zanaflex if you are allergic to tizanidine, or if you are also taking the antidepressant fluvoxamine (Luvox), or the antibiotic ciprofloxacin (Cipro).

Before using Zanaflex, tell your doctor if you are allergic to any drugs, or if you have:

  • liver disease;

  • kidney disease;

  • high or low blood pressure; or

  • a history of "Long QT syndrome."

If you have any of these conditions, you may not be able to use Zanaflex, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether Zanaflex passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. In older adults, Zanaflex may take much longer to clear from the body. Follow your doctor's instructions about your specific dosage and medication schedule.

How should I take Zanaflex?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Take this medication with a full glass of water.

Zanaflex is a short-acting medication, and its effects will be most noticeable between 1 and 6 hours after you take it. This medication should be taken only for daily activities that require relief from muscle spasticity.

In most cases, you may take up to three doses in one day if needed. Allow 6 to 8 hours to pass between doses.

Carefully follow your doctor's instructions about taking this medication with or without food. Taking Zanaflex tablets with food can increase the levels of Zanaflex in your blood stream, but taking Zanaflex capsules with food can decrease the levels.

Switching between Zanaflex tablets and capsules, or changing the way you take it with regard to eating, can cause an increase in side effects or a decrease in therapeutic effect. Follow your doctor's instructions carefully. After making any changes in how you take Zanaflex, contact your doctor if you notice any change in how well the medicine works or if it causes increased side effects.

Do not take more than three doses (36 mg) in a 24-hour period. Too much of this medication can damage your liver.

To be sure this medication is not causing harmful effects, your liver function will need to be tested on a regular basis. Do not miss any scheduled visits to your doctor.

You may have withdrawal symptoms such as dizziness, fast heart rate, tremors, anxiety, and increased spasticity when you stop using Zanaflex after using it over a long period of time. Do not stop using this medication suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

Store Zanaflex at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include drowsiness, confusion, slow heart rate, shallow breathing, feeling light-headed, fainting, or coma.

What should I avoid while taking Zanaflex?

Zanaflex can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Dizziness is most likely to occur when you rise from a sitting or lying position. Get up slowly to prevent dizziness and a possible fall. Do not use Zanaflex at a time when muscle tone is needed to assure safe balance and movement for certain activities. In some situations, it may endanger your physical safety to be in a state of reduced muscle tone. Cold or allergy medicine, narcotic pain medicine, sleeping pills, other muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by Zanaflex. Tell your doctor if you need to use any of these other medicines together with Zanaflex. Avoid drinking alcohol. It can increase some of the side effects of Zanaflex.

Zanaflex side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:
  • feeling light-headed, fainting, slow heart rate;

  • hallucinations, confusion, unusual thoughts or behavior;

  • nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or

  • burning or pain when you urinate.

Less serious Zanaflex side effects may be more likely to occur, such as:

  • drowsiness or dizziness;

  • feeling anxious or nervous;

  • numbness or tingling;

  • stomach pain, diarrhea, constipation, vomiting;

  • fever;

  • dry mouth;

  • muscle weakness, back pain;

  • increased muscle tone or spasms; or

  • sweating or skin rash.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Zanaflex?

Before taking Zanaflex, tell your doctor if you are using any of the following drugs:

  • acyclovir (Zovirax);

  • cimetidine (Tagamet);

  • famotidine (Pepcid);

  • ticlopidine (Ticlid),

  • zileuton (Zyflo);

  • birth control pills;

  • antibiotics such as enoxacin (Penetrex), gatifloxacin (Tequin), levofloxacin (Levaquin), lomefloxacin (Maxaquin), moxifloxacin (Avelox), ofloxacin Floxin), sparfloxacin (Zagam), trovafloxacin (Trovan), or norfloxacin (Noroxin);

  • blood pressure medications such as clonidine (Catapres), guanabenz (Wytensin), guanfacine (Tenex), or methyldopa (Aldomet); or

  • heart rhythm medications such as amiodarone (Cordarone, Pacerone), mexiletine (Mexitil), propafenone (Rhythmol), and verapamil (Calan, Covera, Isoptin).

If you are using any of these drugs, you may not be able to use Zanaflex, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect Zanaflex. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

For the Consumer

Applies to tizanidine: oral capsule, oral tablet

Along with its needed effects, tizanidine (the active ingredient contained in Zanaflex) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur while taking tizanidine:

More common
  • Chest pain or discomfort
  • fever
  • loss of appetite
  • lower back or side pain
  • nausea and/or vomiting
  • nervousness
  • pain or burning while urinating
  • painful or difficult urination
  • sores on the skin
  • tingling, burning, or prickling sensations
  • unusual tiredness
  • yellow eyes or skin
Less common
  • Black, tarry stools
  • bloody vomit
  • blurred vision
  • chills or sore throat
  • coldness
  • convulsions (seizures)
  • cough or hoarseness
  • dark urine
  • dry, puffy skin
  • eye pain
  • fainting
  • influenza (flu)-like symptoms
  • irregular heartbeat
  • kidney stones
  • persistent anorexia
  • pruritus
  • right upper quadrant tenderness
  • seeing things that are not there
  • shortness of breath
  • slow or irregular heartbeat
  • unusual tiredness or weakness
  • weight gain
Incidence not known
  • Continuing vomiting
  • general feeling of tiredness or weakness
  • headache
  • light-colored stools

Get emergency help immediately if any of the following symptoms of overdose occur while taking tizanidine:

Symptoms of overdose
  • Blurred vision
  • change in consciousness
  • chest pain or discomfort
  • confusion
  • decreased awareness or responsiveness
  • difficult or troubled breathing
  • dizziness, faintness or lightheadedness when getting up from a lying position
  • irregular, fast or slow, or shallow breathing
  • lightheadedness, dizziness or fainting
  • loss of consciousness
  • pale or blue lips, fingernails, or skin
  • severe sleepiness
  • shortness of breath
  • sleepiness or unusual drowsiness
  • slow or irregular heartbeat
  • sweating
  • unusual tiredness or weakness

Some side effects of tizanidine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Anxiety
  • back pain
  • constipation
  • depression
  • diarrhea
  • difficulty in speaking
  • dizziness or lightheadedness, especially when getting up from a lying or sitting position
  • drowsiness
  • dry mouth
  • heartburn
  • increased sweating
  • increased muscle spasms or tone
  • muscle weakness
  • pain or burning in throat
  • runny nose
  • skin rash
  • sleepiness
  • stomach pain
  • uncontrolled movements of the body
Less common
  • Difficulty swallowing
  • dry skin
  • general feeling of discomfort or illness
  • increased need to urinate
  • joint or muscle pain or stiffness
  • loss of hair
  • migraine headache
  • mood changes
  • neck pain
  • passing urine more often
  • shivering
  • swelling of feet or lower legs
  • swollen area that feels warm and tender
  • trembling or shaking
  • trouble sleeping
  • unusual feeling of well-being
  • unusual tiredness or weakness
  • weight loss

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Applies to tizanidine: oral capsule, oral tablet

Nervous system

Visual hallucinations were observed in 3% (n=5) of patients in 2 clinical trials. Patients were aware the events were not real in most cases, and in only one case did problems persist following discontinuation. Sedation appears to be dose related in single dose studies and may in approximately 10% of cases be severe enough to interfere with daily activities. In multiple dose studies, however, the incidence of sedation peaked following one week of treatment, and remained stable thereafter.

Nervous system side effects have frequently been associated with the use of this tizanidine. Sedation, somnolence, and asthenia have been reported in up to 48% of patients. Dizziness has been reported in 16% of patients. Duskiness, hallucinations, nervousness, insomnia, and speech disorder have been reported rarely.

Gastrointestinal

Gastrointestinal side effects have included dry mouth in approximately 50% and constipation or vomiting in less than 4% of patients.

Hepatic

Most cases of elevated liver function tests in patients receiving tizanidine (the active ingredient contained in Zanaflex) rapidly resolved upon removal of the medication. Of the three deaths reported, two patients had symptoms of liver disease following 2 months of treatment while one occurred following 11 days. Two of the patients were receiving other medications that have been associated with hepatic toxicity.

Hepatic side effects associated with the use of tizanidine have included elevations of liver function tests to greater than 3 times the upper normal limit in 5% of patients. Three deaths associated with liver failure have been reported during postmarketing surveillance in patients receiving tizanidine.

Cardiovascular

Cardiovascular side effects have included hypotension and bradycardia. Rarely, severe hypotension associated with use of this drug has required IV fluids, epinephrine, and dopamine.

The manufacturer reports a single dose study that found hypotension in 16% and 30% of patients following an 8 and 16 mg dose, respectively. The occurrence of bradycardia under the same circumstances was 2% and 10%.

Ocular

Ocular side effects including blurred vision have been reported rarely.

Dermatologic

Dermatologic side effects have been isolated to rashes.

Other

Other side effects have included three cases of rebound symptoms on sudden withdrawal of tizanidine (the active ingredient contained in Zanaflex) Withdrawal symptoms included hypertension, tachycardia, hypertonia, tremor, and anxiety.

The withdrawal case reports suggested that these patients were also misusing narcotics.