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Muscle Relaxants and Alcohol Interactions

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Nov 18, 2019.

Skeletal muscle relaxants work primarily in the spinal cord and brain, also called the central nervous system, to block pain sensations between the nerves and the brain. They relieve painful muscle spasms and spasticity due to conditions like acute back pain or multiple sclerosis. Alcohol should be avoided if you are under treatment with a centrally-acting muscle relaxant.

When muscle relaxants are combined with alcohol (ethanol), side effects such as drowsiness, confusion, dizziness, and errors in judgement can occur. Driving may be more hazardous and should always be avoided. These side effects may be especially common and serious in the older patient.

Skeletal muscle relaxants are a varied group of medications commonly used to treat several conditions:

  • Spasticity (painful stiff and rigid muscles) from upper motor neuron syndromes such as cerebral palsy, multiple sclerosis, traumatic brain injury, or stroke. Baclofen and dantrolene are often used.
  • Muscle spasms and tension from painful muscle conditions that are usually short-lived and linked with conditions like acute injury, back pain, tension headaches, or fibromyalgia. Metaxalone, cyclobenzaprine, and methocarbamol may be prescribed.
  • Botulinum toxin is FDA approved to treat spasticity in certain muscle groups of the upper and lower limbs. These products are also used for cervical dystonia, when the neck muscles involuntarily contract causing your head to uncontrollably tilt forward or backward.

Some muscle relaxers are available in a combination drug with an anti-inflammatory agent like aspirin. They may be combined with non-steroidal anti-inflammatory agents (NSAIDs) for added pain relief. Rest and physical therapy are also important in the overall treatment plan for muscle spasm pain relief.

Table 1. Common Muscle Relaxants

Alcohol should be avoided if you are under treatment with a central-acting muscle relaxant.

Previous research from the Substance Abuse and Mental Health Services Administration (SAMHSA) has shown that up to 18% of emergency department cases involving skeletal muscle relaxants also were linked with alcohol consumption. Carisoprodol and cyclobenzaprine are frequently misused for non-medical reasons.

  • Centrally-acting agents can lead to added central nervous system depression when consumed with alcohol. Side effects such as dizziness, drowsiness, sedation, confusion, weakness and problems with judgement or thinking can occur.
  • Avoid hazardous activities such as driving or operating dangerous machinery, or engaging in high-risk activities.
  • Carisoprodol (Soma) is metabolized to meprobamate and can lead to an opiate-like effect when combined with alcohol.
  • A few muscles relaxers, such as the botulinum toxins (Botox, Dysport, Myobloc) and dantrolene work directly on muscle fibers in the peripheral nervous system. The botulinum toxins are not reported to have an interaction with alcohol. However, dantrolene can cause CNS depression and use with alcohol should be avoided.
  • In addition to CNS depression, tizanidine may also have additive effects on lowering your blood pressure (hypotension) if combined with alcohol. You may experience headache, drowsiness, dizziness, lightheadedness, fainting, falling, difficulty concentrating, and/or changes in pulse or heart rate. Use caution when rising from a sitting or lying position.

Muscle relaxants are not recommended for use by pregnant women, older adults, or people who have a history of depression or drug or alcohol abuse.

Table 1 may not be a complete list; always check with your pharmacist for possible drug-alcohol interactions. Be sure to inform them of your prescription medications, as well as over-the-counter (OTC), herbal and vitamin products that you use.

Types of Drug Interactions With Alcohol

Sources

  1. Witenko C, Moorman-Li R, Motycka C, et al. Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. P T. 2014;39(6):427–435. Accessed Nov. 18, 2019 at PMID: 25050056
  2. Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013. HHS Publication No. (SMA) 13-4760, DAWN Series D-39.
  3. What are the Effects of Mixing Flexeril and Alcohol? Alcohol.org. Accessed Nov. 18, 2019 at https://www.alcohol.org/mixing-with/flexeril/
  4. Amrix Product Label. ECR Pharmaceuticals Inc.. Richmond, Virginia. Accessed Nov. 18, 2019 at https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/021777lbl.pdf

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.