Flexeril (cyclobenzaprine) is classified as a muscle relaxant. Flexeril is primarily used to relieve muscle spasms and pain associated with musculoskeletal conditions. It is not effective for relieving muscle spasms due to central nervous system disorders and diseases, such as multiple sclerosis, amyotrophic lateral sclerosis, or a brain or spinal cord injury. It is typically prescribed for acute back injuries and other forms of conditions where pain and muscle spasms are involved.
Flexeril’s primary action occurs in the brainstem, with some involvement occurring at the level of spinal cord. It also has several off-label uses; the most common off-label use for Flexeril is for the treatment of fibromyalgia pain and associated muscle spasms. Other off-label uses are listed as treatments for:
- Tension headaches
- Migraine headaches
- Tinnitus (ringing in the ears)
Flexeril is not listed by the United States Drug Enforcement Agency as a controlled substance; however, it can only be legally purchased with a doctor’s prescription and should be taken under the supervision of a doctor for treatment of a specific medical condition. Flexeril is typically used in conjunction with physical therapy or exercise and other forms of treatment for these conditions. Cyclobenzaprine is available in:
- Capsule form (extended-release brand name Amrix)
- Suspension (powder from)
- Tablet form
Cyclobenzaprine was synthesized in 1961 and is chemically related to a group of antidepressant medications known as the tricyclic antidepressants. It was found to have limited effects in treating depression and did not compare favorably to the available antidepressants at that time; however, it was noted that the drug did act as a central muscle relaxant.
Flexeril was approved by the FDA in 1977 for the treatment of acute muscle spasms. It is manufactured by Merck & Co. and marketed and distributed by McNeil Consumer & Specialty Pharmaceuticals.
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For the majority of patients using Flexeril, the recommended dosage appears to be 5 mg three times a day. Depending on the response of the individual, the dosage may be increased to 10 mg three times a day. For elderly patients and children, the dosages can be different. The use of Flexeril for periods longer than 2-3 weeks is not recommended. Typically, the medication is used for the short-term treatment of acute muscle spasms and muscle pain in conjunction with other forms of therapy. The evidence for its treatment utility indicates that beyond the 2-3 week window, it is not very effective in the treatment of muscle spasms.
Because Flexeril is structurally related to the tricyclic antidepressants, its hypothesized primary action is anticholinergic, meaning that it blocks the neurotransmitter epinephrine in the brain (at the same time strengthening the activity of norepinephrine).
The action of Flexeril is believed to work on two types of motor neurons in the brain and possibly spinal cord (alpha and gamma neurons) that are involved in the production of movement. Flexeril reduces the rate at which these neurons fire and therefore decreases the intensity and frequency of muscle spasms in people. It may also reduce pain that is associated with spasms, but pain reduction is not its primary treatment effect.
The onset of action (the time that it takes a drug to achieve its effects) is about 60 minutes. The half-life for Flexeril varies – it’s 8-37 hours for the immediate-release form, and 32-33 hours for the extended-release form. It remains in the system for a relatively long period, and this period may even be longer in young or elderly individuals.
There are several proposed advantages to using Flexeril to treat muscle spasms:
- Due to its quick onset of action, it relieves symptoms quickly.
- It has a wealth of research supporting its use in the treatment of musculoskeletal conditions.
- It is believed to have a low-level potential for the development of physical dependence (see below).
- It is listed as Pregnancy Category B, meaning that is considered safe for women to use when they are pregnant; however, it should still be used with caution by pregnant women.
- It is believed to be useful in treating insomnia due to severe muscle spasms.
Some disadvantages include:
- Due to its pharmacological properties, Flexeril use commonly causes sedation and can interfere with a person’s ability to effectively perform daily activities.
- Because of its relatively long half-life, people can experience hangover effects in the morning because of the accumulation of the drug in the system after multiple dosing.
- Flexeril has the potential to produce life-threatening interactions with other drugs that are taken at the same time such as certain antidepressant drugs (particularly MAO inhibitors).
- Because Flexeril is similar to tricyclic antidepressants, it also has a potential to produce antidepressant toxicity if abused. This includes such symptoms as altered mental status, hallucinations , irregular heartbeat, hypotension, dry mouth, and intestinal problems. At extremely high doses, there is a potential for coma, heart attack, and even death
Can Flexeril Use Become Addictive?
Flexeril use does not appear to produce physical dependence despite its potential to produce a mild withdrawal syndrome after prolonged use. However, there is a potential for a drug that produces sedation to be used in conjunction with other drugs and to be abused. Feelings of sedation and being relaxed are often interpreted by certain individuals as pleasurable even though they may not deliver the euphoria that other types of drugs deliver.
Flexeril abuse is well documented. For instance there was an 87 percent increase from the years 2004 to 2011 in the number of emergency room visits due to Flexeril abuse. Moreover, since the drug Soma was reclassified to a Schedule IV drug by the DEA, it appears that Flexeril abuse may have increased. Thus, abuse of Flexeril is a concern. Its street names include cyclone and mellow yellow.
The effects of Flexeril are enhanced when combined with other drugs, such as alcohol, benzodiazepines, and opiates. It appears as if at least some of the abuse of Flexeril occurs in this context. Moreover, the use of Flexeril beyond the 2-3 week timeframe for its therapeutic effects would also indicate abuse, as would buying Flexeril without a prescription or using it in a manner that it is not intended to be used.
There is a potential for psychological addiction to occur with prolonged abuse to Flexeril due to a couple of reasons:
- Any drug or behavior that has a potential for abuse or addiction involves the recruitment of the neurotransmitter dopamine in an area of the brain known as the nucleus accumbens.
- This area of the brain is important in the feeling of reinforcement or reward that is associated with repeating a particular behavior.
- Any drug or activity that is reinforced by pleasurable associations has the potential to be at least psychologically addicting, and this potential is enhanced if the drug is associated with withdrawal symptoms.
As Flexeril abuse often occurs in conjunction with the abuse of other drugs, such as alcohol, the potential for abuse/addiction is strong.
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A number of signs can point to a problem with Flexeril abuse or even a psychological addiction to the drug. Some general signs include:
- Loss of interest in regular activities
- Dishonesty and/or secrecy regarding one’s use of Flexeril
- Taking larger doses of Flexeril than prescribed
- Taking Flexeril more frequently than prescribed
- Taking Flexeril regularly without having a prescription
- Taking the drug for reasons not specified, such as to “feel good” or cope with normal everyday situations
- Continuing to use the drug in spite of experiencing negative consequences
- Spending more time trying to get Flexeril
- Having to suspend activities to recover after using it
- Being unsuccessful in quitting use of the drug
- Declining performance at work or in school
- Negative consequences in personal relationships as a result of use
- Missing important commitments as a result of using the drug
- Getting angry when people mention that you are using the drug too often
- Changes in physical appearance that include such things as being disheveled or lax in one’s grooming habits
Trying to point out someone’s dysfunctional behavior, particularly when it involves drug abuse, can be difficult. There are several concerns one should be aware of before approaching a friend or family member with this issue. The major concern one should have is that people with drug abuse issues will often not be very responsive and can even be abusive to others when attempting to discuss the issues with them. In fact, many individuals with drug abuse issues do not consider their use of the drug to be abusive.
There are several other major considerations and suggestions for approaching an individual and discussing abuse of drugs with them:
- Be aware that the responsibility for any change is on the person with the problem and not with loved ones.
- Be fully cognizant of the goals you have in discussing the issue with the person.
- Be objective and point out issues with the person’s behavior that suggest an abuse problem.
- Try to remain calm and not to be confrontational.
- If the discussion becomes an argument, it may be best to break it off and try again at another time.
- Do not use threats.
- Try to frame your concerns in the form of questions.
- Avoid making accusations.
- Attempt to make the conversation as positive as possible.
- Expect the person to be resistant.
- Be willing to end the conversation if the person becomes upset.
- Aim to be understanding.
- Offer to be available to help the person or to discuss these issues later.
Depending on the situation, the person’s response, and the severity of the abuse issue, it may be more productive to schedule a formal intervention.
An intervention is a more formal discussion with an individual who has a problem that affects other people. Interventions recruit relatives and close friends to come together and point out these issues with the person of interest. One should not attempt to organize an intervention without guidance from a professional, such as an addiction counselor, interventionist, family mediator, physician, or other specialist. The professional can organize the intervention, keep it focused, and adjust the plan in order to make it a positive experience. Understand the following about an intervention:
- The goal of intervention is simply to help the individual realize that there is a problem and for that person to consider getting help.
- The goal of intervention is not to force the person into treatment, although the person may agree to getting treatment, but to get the person at the very least to consider that there is a problem and to present options to the person to address the problem.
- To reach these goals, people involved in the intervention take turns discussing the issue with the person and how it affects them.
- The person suffering with drug abuse is given an opportunity to respond and the professional monitors the process.
- The options are discussed with the intervention subject, and the person may agree or disagree with the conclusions.
Treatment for Flexeril Abuse
Getting treatment for Flexeril abuse is not significantly different from substance abuse treatment in general. It is often useful to enroll the help of a physician in any substance abuse treatment program; however, it is not always necessary unless there are serious withdrawal symptoms associated with discontinuing the drug of choice. Since the discontinuation syndrome from stopping Flexeril is comparatively mild, it becomes a personal choice to include a physician to assist with discontinuing the drug. Medical detox is not generally necessary for Flexeril withdrawal, but medical professionals can help make the process more comfortable. If other drugs of abuse are also involved, medical detox may be necessary.
Typically, the person with the abuse problem will need to:
- Be made aware that the probability of success is greater if help is accepted as opposed to trying to address the abuse alone.
- Engage in some formal drug abuse/addiction recovery program.
- Understand that often combining individual counseling, alternative therapies, and 12-Step programs can be useful.
- Realize that abuse of Flexeril may illustrate that certain psychological needs are unmet or unrealized, and the person will need to understand and address these needs.
- Seek the support of family, friends, and others in recovery, as support can be crucial in helping a person achieve and maintain recovery.
Although it is often considered to have a low potential for abuse, people do abuse Flexeril and such abuse can have serious consequences. People who receive understanding and support regarding their Flexeril abuse can be successful in making positive changes in their lives and getting off the drug.