Doxylamine: (Moderate) Monitor for unusual drowsiness and sedation, urinary retention, and reduced gastric motility during coadministration of cyclobenzaprine and doxylamine. Monitor patients for serotonin syndrome if concomitant use is necessary, particularly during treatment initiation and dosage increases. Rivastigmine inhibits acetylcholinesterase, the enzyme responsible for the degradation of acetylcholine, and improves the availability of acetylcholine. Discard any unused portion of the capsules. Chlordiazepoxide; Amitriptyline: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. generic drugs) are not considered. If serotonin syndrome occurs, consider discontinuation of therapy. Apomorphine causes considerable somnolence, and concomitant administration of apomorphine and CNS agents like cyclobenzaprine could result in additive CNS effects. (Moderate) Monitor for signs or symptoms of anticholinergic toxicity during concomitant cyclobenzaprine and homatropine use. Portions of this document last updated: May 01, 2023. Limit the use of opioid pain medications with cyclobenzaprine to only patients for whom alternative treatment options are inadequate. Safinamide: (Contraindicated) Safinamide is contraindicated for use with cyclobenzaprine due to the risk of serotonin syndrome. Anecdotal evidence from case reports suggests that the drug may possess serotonin augmenting effects, which may be clinically relevant in some instances. Highly clinically significant. Chronic use in individuals with complications due to selected conditions may be indicated, although close monitoring is warranted. Triprolidine: (Moderate) Cyclobenzaprine and sedating antihistamines such as triprolidine both exhibit anticholinergic activity, and anticholinergic side effects can be additive. Patients should be advised to avoid driving or other tasks requiring mental alertness until they know how the combination affects them. Use of cyclobenzaprine or high doses of orphenadrine may result in significant anticholinergic activity, thereby interfering with the therapeutic effect of rivastigmine. Rinse the mouth to ensure all contents have been swallowed. Sodium Oxybate: (Major) Sodium oxybate should not be used in combination with CNS depressant anxiolytics, sedatives, and hypnotics or other sedative CNS depressant drugs. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Maprotiline: (Major) Concurrent use of cyclobenzaprine should generally be avoided in patients taking maprotiline due to the additive risk of similar pharmacology and side-effect profiles. Treatment duration beyond 2 to 3 weeks is not recommended. If serotonin syndrome occurs, consider discontinuation of therapy. Donepezil; Memantine: (Moderate) The use of cyclobenzaprine may result in significant anticholinergic activity, thereby interfering with the therapeutic effect of donepezil. Treatment with the drug reduces pain and tenderness and improves mobility. Ozanimod: (Contraindicated) Coadministration of ozanimod with cyclobenzaprine is contraindicated. information highlighted below and resubmit the form. The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Dosage adjustments of either or both drugs may be necessary. Concomitant use may result in additive CNS depression or anticholinergic effects. How it works Cyclobenzaprine may be used to relieve muscle spasms. Lofexidine can potentiate the effects of CNS depressants. Combination therapy can cause additive effects of sedation and dizziness, which can impair the patient's ability to undertake tasks requiring mental alertness. Monitor patients who take benzodiazepines with another CNS depressant for symptoms of excess sedation. Hepatic cytochrome P-450 isoenzymes (CYP3A4, CYP1A2, and to a lesser extent CYP2D6) are primarily responsible for the N-demethylation pathway of cyclobenzaprine metabolism (one of the oxidative pathways). Monitor patients who take benzodiazepines with another CNS depressant for symptoms of excess sedation. If serotonin syndrome occurs, consider discontinuation of therapy. If serotonin syndrome occurs, consider discontinuation of therapy. The hypotensive effect of clonidine may be reduced by tricyclic antidepressants, and cyclobenzaprine is structurally related to the tricyclic antidepressants. Hydrocodone: (Major) Concomitant use of hydrocodone with cyclobenzaprine may cause respiratory depression, hypotension, profound sedation, and death and increase the risk for serotonin syndrome and anticholinergic effects. Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. Promethazine; Phenylephrine: (Moderate) Monitor for unusual drowsiness and sedation, urinary retention, and reduced gastric motility during coadministration of cyclobenzaprine and promethazine. Monitor for anticholinergic-related effects such as constipation and urinary retention. Aspirin low strength is used to treat the following conditions: Angina Angina Pectoris Prophylaxis Heart Attack Ischemic Stroke Ischemic Stroke, Prophylaxis Myocardial Infarction, Prophylaxis Niacin Flush Prevention of Thromboembolism in Atrial Fibrillation Prosthetic Heart Valves - Thrombosis Prophylaxis Aspirin Low Strength. Hyperpyretic crisis, seizures and deaths have occurred in patients receiving cyclobenzaprine or structurally similar tricyclic antidepressants concomitantly with MAO inhibitor drugs. If these drugs must be used together, closely monitor the patient for signs and symptoms of serotonin syndrome. Our original studies have been referenced on 600+ medical publications including The Lancet, Mayo Clinic Proceedings, and Nature. Concomitant use may increase the risk for additive CNS depression, anticholinergic adverse events, and serotonin syndrome. Monitor for signs of urinary retention or reduced gastric motility during coadministration. Aspirin, ASA; Oxycodone: (Major) Concomitant use of oxycodone with cyclobenzaprine may cause respiratory depression, hypotension, profound sedation, and death and increase the risk for serotonin syndrome and anticholinergic effects. Bupropion: (Moderate) Use extreme caution when coadministering bupropion with other drugs that lower the seizure threshold, such as cyclobenzaprine. (Moderate) Concomitant use of skeletal muscle relaxants with barbiturates can result in additive CNS depression. With medical big data and proven AI algorithms, eHealthMe provides a platform for everyone to run phase IV clinical trials. Dosage of drugs is not considered in the study. The anticholinergic effects of cyclobenzaprine may be additive with other anticholinergic medications, particularly in the older adult. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. COMT inhibitors have also been associated with sudden sleep onset during activities of daily living such as driving, which has resulted in accidents in some cases. Peak plasma concentrations and AUC of cyclobenzaprine are nearly doubled in patients with hepatic impairment (15 of 16 patients studied had mild hepatic impairment). Cyclobenzaprine should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure. Molindone: (Moderate) Simultaneous use of skeletal muscle relaxants and other CNS depressants, such as molindone, can increase CNS depression. 5705185. Avoid prescribing opioid cough medication in patients taking cyclobenzaprine. Olanzapine; Fluoxetine: (Major) Because of the potential risk and severity of serotonin syndrome, concurrent use of cyclobenzaprine with other drugs that have serotonergic properties, such as the selective serotonin reuptake inhibitors (SSRIs), should generally be avoided. Cyclobenzaprine possesses antimuscarinic properties, which can cause dry mouth, urinary difficulties and slowing of gastrointestinal motility. Phenobarbital: (Moderate) Concomitant use of skeletal muscle relaxants with barbiturates can result in additive CNS depression. Additive CNS depression causing sedation and/or dizziness is also possible. What is Aspirin? Do not take this drug for more than 3 weeks without talking to your doctor. Loxapine is a central nervous system (CNS) depressant. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Monitor for anticholinergic-related effects such as constipation and urinary retention. seizures / Delayed / 0-1.0anaphylactoid reactions / Rapid / 0-1.0angioedema / Rapid / 0-1.0anaphylactic shock / Rapid / 0-1.0SIADH / Delayed / Incidence not knownstroke / Early / Incidence not knownmyocardial infarction / Delayed / Incidence not knownileus / Delayed / Incidence not knownserotonin syndrome / Delayed / Incidence not known, palpitations / Early / 0-6.0confusion / Early / 1.0-3.0blurred vision / Early / 1.0-3.0constipation / Delayed / 1.0-3.0ataxia / Delayed / 0-1.0excitability / Early / 0-1.0hallucinations / Early / 0-1.0psychosis / Early / 0-1.0hypertonia / Delayed / 0-1.0dysarthria / Delayed / 0-1.0urinary retention / Early / 0-1.0hypotension / Rapid / 0-1.0sinus tachycardia / Rapid / 0-1.0peripheral vasodilation / Rapid / 0-1.0cholestasis / Delayed / 0-1.0hepatitis / Delayed / 0-1.0jaundice / Delayed / 0-1.0gastritis / Delayed / 0-1.0peripheral neuropathy / Delayed / Incidence not knowndyspnea / Early / Incidence not knowngalactorrhea / Delayed / Incidence not knownimpotence (erectile dysfunction) / Delayed / Incidence not knowntesticular swelling / Early / Incidence not knownchest pain (unspecified) / Early / Incidence not knownhypertension / Early / Incidence not knownedema / Delayed / Incidence not knownhyperglycemia / Delayed / Incidence not knownhypoglycemia / Early / Incidence not knownstomatitis / Delayed / Incidence not knownthrombocytopenia / Delayed / Incidence not knownleukopenia / Delayed / Incidence not knowneosinophilia / Delayed / Incidence not known, xerostomia / Early / 6.0-58.0drowsiness / Early / 16.0-39.0dizziness / Early / 3.0-19.0headache / Early / 1.0-17.0nausea / Early / 1.0-8.0fatigue / Early / 1.0-6.0tremor / Early / 0-6.0dysgeusia / Early / 6.0-6.0acne vulgaris / Delayed / 6.0-6.0dyspepsia / Early / 1.0-4.0asthenia / Delayed / 1.0-3.0irritability / Delayed / 1.0-3.0vertigo / Early / 0-1.0agitation / Early / 0-1.0diplopia / Early / 0-1.0paresthesias / Delayed / 0-1.0malaise / Early / 0-1.0anxiety / Delayed / 0-1.0insomnia / Early / 0-1.0tinnitus / Delayed / 0-1.0urticaria / Rapid / 0-1.0pruritus / Rapid / 0-1.0rash / Early / 0-1.0increased urinary frequency / Early / 0-1.0flatulence / Early / 0-1.0abdominal pain / Early / 0-1.0diarrhea / Early / 0-1.0vomiting / Early / 0-1.0anorexia / Delayed / 0-1.0diaphoresis / Early / 0-1.0weakness / Early / 0-1.0paranoia / Early / Incidence not knownbreast enlargement / Delayed / Incidence not knowngynecomastia / Delayed / Incidence not knownlibido decrease / Delayed / Incidence not knownlibido increase / Delayed / Incidence not knownsyncope / Early / Incidence not knownweight gain / Delayed / Incidence not knowntongue discoloration / Delayed / Incidence not knownweight loss / Delayed / Incidence not knownalopecia / Delayed / Incidence not knownphotosensitivity / Delayed / Incidence not knownmyalgia / Early / Incidence not knownpurpura / Delayed / Incidence not known. Limit the use of opioid pain medications with cyclobenzaprine to only patients for whom alternative treatment options are inadequate. The time to the peak concentration of cyclobenzaprine varies depending on the formulation taken (around 7 hours for the extended-release form). Limit the use of opioid pain medications with cyclobenzaprine to only patients for whom alternative treatment . Particular attention should be paid to GI problems because of the possible development of paralytic ileus. All rights reserved. 19.79. Alcohol may potentiate the side effects of cyclobenzaprine. Concomitant use may result in additive anticholinergic adverse effects. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Monitor for anticholinergic-related effects such as constipation and urinary retention. Monitor patients for serotonin syndrome if concomitant use is necessary, particularly during treatment initiation and dosage increases. Save 2.20. Monitor for anticholinergic-related effects such as constipation and urinary retention. Chlorpheniramine; Dextromethorphan; Phenylephrine: (Moderate) Cyclobenzaprine and sedating antihistamines such as chlorpheniramine both exhibit anticholinergic activity, and anticholinergic side effects can be additive. Dosage adjustments of either or both drugs may be necessary. Carbinoxamine; Phenylephrine: (Moderate) Cyclobenzaprine and sedating antihistamines such as carbinoxamine both exhibit anticholinergic activity, and anticholinergic side effects can be additive. Alternative therapy to cyclobenzaprine should be considered in patients with tricyclic antidepressant hypersensitivity, particularly if the reaction was severe or life-threatening. Utilize appropriate caution if these drugs are given together. Estazolam: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. Monitor for anticholinergic-related effects such as constipation and urinary retention. Monitor patients who take benzodiazepines with another CNS depressant for symptoms of excess sedation. Always consult your healthcare provider. Monitor for signs of urinary retention or reduced gastric motility during coadministration. Educate patients about the risks and symptoms of excessive CNS depression. Dosage adjustments of either or both drugs may be necessary. At the standard dose of 10 mg to 30 mg a day, cyclobenzaprine (formerly branded as Flexeril) will make you sleepy. Avoid concomitant use if possible and monitor for serotonin syndrome if use is necessary. Entacapone: (Moderate) COMT inhibitors should be given cautiously with other agents that cause CNS depression, including skeletal muscle relaxants, due to the possibility of additive sedation. Chlorpheniramine: (Moderate) Cyclobenzaprine and sedating antihistamines such as chlorpheniramine both exhibit anticholinergic activity, and anticholinergic side effects can be additive. Galantamine: (Moderate) Concurrent use of certain muscle relaxants, such as cyclobenzaprine with galantamine should be avoided if possible. eHealthMe is studying from 27,082 Cialis users for its effectiveness, alternative drugs and more. Monitor for anticholinergic-related effects such as constipation and urinary retention. Concomitant use may increase the risk for additive CNS depression, anticholinergic adverse events, and serotonin syndrome. Sufentanil: (Major) Concomitant use of sufentanil with cyclobenzaprine may cause respiratory depression, hypotension, profound sedation, and death. Write a review. Concomitant use of these drugs has resulted in hyperpyretic crisis seizures and death. Pentobarbital: (Moderate) Concomitant use of skeletal muscle relaxants with barbiturates can result in additive CNS depression. Drug Interactions FLEXERIL may have life-threatening interactions with MAO inhibitors. Relieves muscle spasms associated with acute, painful, musculoskeletal conditions. It is recommended that the injectable buprenorphine dose be halved for patients who receive other drugs with CNS depressant effects; for the buprenorphine transdermal patch, start with the 5 mcg/hour patch. Ombitasvir; Paritaprevir; Ritonavir: (Moderate) Systemic exposure and the maximum serum concentration (Cmax) of cyclobenzaprine were decreased when a single 5 mg dose was administered concurrently with ombitasvir; paritaprevir; ritonavir. Doxylamine; Pyridoxine: (Moderate) Monitor for unusual drowsiness and sedation, urinary retention, and reduced gastric motility during coadministration of cyclobenzaprine and doxylamine. Chlorpromazine: (Moderate) Additive anticholinergic effects may be seen when chlorpromazine is used concomitantly with other drugs with antimuscarinic activity such as cyclobenzaprine. It is extensively metabolized and undergoes enterohepatic recirculation. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Cyclobenzaprine and sedating antihistamines such as chlorpheniramine both exhibit anticholinergic activity, and anticholinergic side effects can be additive. eHealthMe is studying from 27,082 Cialis users for its effectiveness, alternative drugs and more. If these drugs are given together, monitor for reduced cyclobenzaprine efficacy; consider increasing the cyclobenzaprine dose if clinically needed. The plasma concentrations of cyclobenzaprine are elevated 1.7-fold in older adults relative to younger adults. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. Cyclobenzaprine has significant anticholinergic properties. It is often used in erection problems. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Coadministration with other CNS depressants may also result in additive sedation and impairment. This tool may not cover all possible drug interactions. Codeine: (Major) Concomitant use of codeine with cyclobenzaprine may cause respiratory depression, hypotension, profound sedation, and death and increase the risk for serotonin syndrome and anticholinergic effects. Avoid prescribing opioid cough medication in patients taking cyclobenzaprine. Cyclobenzaprine may not be suitable for people with glaucoma or increased intraocular pressure, a history of urinary retention, or taking other drugs that also have anticholinergic side effects (anticholinergic side effects include constipation, blurred vision, and increase in eye pressure). Chlorpheniramine; Dextromethorphan: (Moderate) Cyclobenzaprine and sedating antihistamines such as chlorpheniramine both exhibit anticholinergic activity, and anticholinergic side effects can be additive. Advise patients to seek medical assistance if they develop any unusual symptoms (including difficulty with swallowing, speaking, or breathing or walking), or if any existing symptom worsens during use of a botulinum toxin. The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome. The concomitant use of serotonergic drugs increases the risk of serotonin syndrome. The half-life ranges from 8 to 37 hours (mean 18 hours). All of her symptoms progressively resolved over the next 3 days. Limit the use of opioid pain medications with cyclobenzaprine to only patients for whom alternative treatment options are inadequate. Amlodipine (Norvasc) is a calcium channel blocker that's prescribed for high blood pressure and chest pain. Additionally, concomitant use may result in serotonin syndrome. Concomitant use increases the risk for serotonin syndrome. Monitor for signs of urinary retention or reduced gastric motility during coadministration. Dosage adjustments of either or both drugs may be necessary. Additive CNS depression causing sedation and/or dizziness is also possible. Cetirizine: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of cetirizine and skeletal muscle relaxants due to the risk for additive CNS depression. Cyclobenzaprine should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure. Cost Important considerations Alternatives Important warnings Other warnings Highlights for Cyclobenzaprine Cyclobenzaprine oral tablet is available as both a generic and brand-name drug. Amrix/Cyclobenzaprine/Cyclobenzaprine Hydrochloride Oral Cap ER: 15mg, 30mgCyclobenzaprine/Cyclobenzaprine Hydrochloride/Fexmid/Flexeril Oral Tab: 5mg, 7.5mg, 10mg. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Monitor patients for serotonin syndrome if concomitant use is necessary, particularly during treatment initiation and dosage increases. Gabapentin: (Major) Initiate gabapentin at the lowest recommended dose and monitor patients for symptoms of sedation and somnolence during coadministration of gabapentin and cyclobenzaprine. If serotonin syndrome occurs, consider discontinuation of therapy. Monitor for anticholinergic-related effects such as constipation and urinary retention. May increase the dose to 7.5 or 10 mg PO 3 times daily based on response. Suvorexant: (Moderate) Cyclobenzaprine may cause additive CNS depression if used concomitantly with other CNS depressants, such as anxiolytics, sedatives, and hypnotics. Diazepam is a benzodiazepine. Antimuscarinic effects may be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation. Approved as a pharmacy medicine, Sanofi will launch Cialis Together in the second half of the year. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Dosage adjustments of either or both drugs may be necessary. Dosage adjustments of either or both drugs may be necessary. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Monitor for signs of urinary retention or reduced gastric motility during coadministration. Concomitant use may increase the risk for additive CNS depression, anticholinergic adverse events, and serotonin syndrome. Additive CNS depression causing sedation and/or dizziness is also possible. The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor patients who take barbiturates with another CNS depressant for symptoms of excess sedation. Cyclobenzaprine should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure. Monitor patients who take benzodiazepines with another CNS depressant for symptoms of excess sedation. If serotonin syndrome occurs, consider discontinuation of therapy. Side Effects. The effects of extended-release tablets last for 24 hours. Tolcapone: (Moderate) COMT inhibitors should be given cautiously with other agents that cause CNS depression, including skeletal muscle relaxants, due to the possibility of additive sedation. For non-prescription products, read the label or package ingredients carefully. Monitor patients who take barbiturates with another CNS depressant for symptoms of excess sedation. If such a reaction occurs, immediately discontinue cyclobenzaprine and any other serotonergic drug. The effects of immediate-release tablets last for four to six hours. (Moderate) Monitor for unusual drowsiness and sedation, urinary retention, and reduced gastric motility during coadministration of cyclobenzaprine and promethazine. Budesonide; Glycopyrrolate; Formoterol: (Moderate) Monitor for signs or symptoms of anticholinergic toxicity during concomitant cyclobenzaprine and glycopyrrolate use. Benztropine: (Moderate) Monitor for signs or symptoms of anticholinergic toxicity during concomitant cyclobenzaprine and benztropine use. Agents that inhibit intestinal motility or prolong intestinal transit time have been reported to induce toxic megacolon. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Also monitor patients for the emergence of serotonin syndrome. Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine: (Moderate) Monitor for signs or symptoms of anticholinergic toxicity during concomitant cyclobenzaprine and hyoscyamine use. Amobarbital: (Moderate) Concomitant use of skeletal muscle relaxants with barbiturates can result in additive CNS depression. Educate patients about the risks and symptoms of respiratory depression and sedation. 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