Tizanidine Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Muscle Spasm

Initial dose: 4 mg orally every 6 to 8 hours (maximum of 3 doses in 24 hours). Dose may be increased in 2 to 4 mg steps to optimum effect and tolerance.

Maintenance dose: 8 mg orally every 6 to 8 hours (maximum of 3 doses in 24 hours)

Maximum dose: Three doses in 24 hours; 12 mg per dose; 36 mg per day

Approved indication: For the acute and intermittent management of increased muscle tone associated with spasticity.

Renal Dose Adjustments

CrCl less than 25 mL/min: Tizanidine should be used with caution as clearance is reduced by more than 50%. During titration the individual doses should be reduced. If higher doses are required, individual doses rather than dosing frequency should be increased. These patients should be monitored closely for the onset or increase in severity of the common adverse events (dry mouth, somnolence, asthenia and dizziness) as indicators of potential overdose.

Liver Dose Adjustments

Tizanidine is extensively metabolized in the liver. Hepatic impairment would be expected to have significant effects on pharmacokinetics of tizanidine. Tizanidine should ordinarily be avoided or used with extreme caution in this patient population.

Dose Adjustments

The dosage of tizanidine must be individualized due to wide interpatient variability in pharmacokinetics, response, and susceptibility to adverse effects.

Tizanidine should be used with caution in elderly patients because clearance is decreased 4-fold.

Dialysis

Data not available

Other Comments

Tizanidine capsules are not interchangeable with tizanidine tablets.

Starting at a lower dose and titrating upward minimizes the risk for adverse effects. Experience with single doses greater than 8 mg and total daily dose greater than 24 mg is limited.

Effects appear to be dose related and gradually diminish within 3 to 6 hours after a dose. Use must be individualized and directed at times and activities where benefit is most important.

Food has complex and different effects on the pharmacokinetics of different tizanidine formulations. These pharmacokinetic differences may result in clinically significant differences when switching administration of the tablet between the fed or fasted state, switching administration of the capsule between the fed or fasted state, switching between the tablet and capsule in the fed state, or switching between the intact capsule and sprinkling the contents of the capsule on applesauce. These changes may result in an increase in adverse events, or delayed or more rapid onset of activity, depending on the nature of the switch. The prescriber should familiarize themselves with the changes in kinetics associated with the use of the different formulations under fasting or fed conditions.

If therapy is to be discontinued, particularly in patients who have been receiving high doses for long periods, the dose should be decreased gradually to minimize the risk of withdrawal and rebound hypertension, tachycardia, and hypertonia.

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