Names and pronunciation
(sye-kloe-ben′za-preen) Amrix
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Drug reference
(sye-kloe-ben′za-preen) Amrix
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Func. class.: Skeletal muscle relax- ant, central acting
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Chem. class.: Tricyclic amine salt
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ACTION: Reduces tonic muscle activ- ity at the brainstem; may be related to antidepressant effects
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USES: Adjunct for relief of muscle spasm and pain in musculoskeletal conditions
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CONTRAINDICATIONS: Acute recovery phase of MI, dysrhythmias, heart block, HF, hypersensitivity, intermit- tent porphyria, thyroid disease, QT pro- longation, within 14 days of MAOIs Precautions: Pregnancy, breastfeeding, geriatric patients, renal/hepatic disease, addictive personality, CV disease, child <15 yr
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SIDE EFFECTS CNS: Dizziness, weakness, drowsiness, headache, insomnia, confusion, nervous- ness, fatigue CV: Postural hypotension, dysrhythmias EENT: Diplopia, temporary loss of vision, blurred vision, dry mouth GI: Nausea, dry mouth, constipation GU: Urinary retention INTEG: Rash
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INTERACTIONS • Do not use within 14 days of MAOIs, traMADol Increase: QT interval—Class IA/III anti- dysrhythmics and other products that C increase QT interval Increase: serotonin syndrome—SSRIs, SNRIs, tricyclics, triptans, fentaNYL, busPIRone, traMADol, traZODone Increase: CNS depression—alcohol, tri- cyclics, opiates, barbiturates, sedatives, hypnotics Drug/Herb Increase: CNS depression—kava, cham- omile, hops, valerian
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TREATMENT OF OVERDOSE: Use anticonvulsants if indicated; monitor cardiac function See Appendix B HIGH ALERT
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DOSAGE AND ROUTES Muscloskeletal disorders • Adult/adolescent ≥15 yr: PO 5 mg tid × 1 wk, max 30 mg/day × 3 wk • Adult: EXTENDED RELEASE 15 mg/ day, max 30 mg/day × 3 wk • Geriatric: PO 5 mg tid Hepatic dose • Adult (mild hepatic disease): PO 5 mg, titrate slowly
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Available forms: Tablets 5, 7.5, 10 mg; extended-release tablets 15, 30 mg
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Administer: • Without regard to meals, give with food for GI symptoms • Do not crush, break, chew extended- release tablets • Store in tight container at room tem- perature
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Assess: • Serotonin syndrome: If using with SSRIs, SNRIs, monitor closely; if syn- drome occurs, discontinue both products immediately, hallucinations, nausea, vom- iting, diarrhea, tachycardia, hyperthermia • Pain: location, duration, mobility, stiff- ness at baseline, periodically • Allergic reactions: rash, fever, respi- ratory distress • Severe weakness, numbness in ex- tremities • Assistance with ambulation if dizzi- ness, drowsiness occurs, especially for geriatric patients • Beers: avoid use in older adults; anti- cholinergic effects • Pregnancy/breastfeeding: no well- controlled studies; use only if clearly needed; use cautiously in breastfeeding
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Evaluate: • Therapeutic response: decreased pain, spasticity; relief of muscle spasms of acute, painful musculoskeletal condi- tions generally short-term; long-term therapy seldom warranted
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to discontinue medication abruptly; that insomnia, nausea, headache, spastic- ity, tachycardia will occur; that product should be tapered off over 1-2 wk • Not to take with alcohol, other CNS depressants or MAOIs • To avoid hazardous activities if drows- iness, dizziness occurs • To avoid using OTC medication (cough preparations, antihistamines) unless directed by prescriber • To use gum, frequent sips of water for dry mouth • To notify prescriber of serotonin syn- drome • To report feeling of fullness of blad- der, inability to void adequate amounts • To use fluids, bulk in diet to prevent constipation
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PHARMACOKINETICS PO: Onset 1 hr, peak 3-8 hr, duration 12-24 hr, half-life 1-3 days, 32 hr extended release, metabolized by liver, excreted in urine, crosses placenta, excreted in breast milk
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• Geriatric: PO 5 mg tid Hepatic dose
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