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INTRODUCTION

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metaxalone (me-tax-a-lone)

Skelaxin

Classification

Therapeutic: skeletal muscle relaxants (centrally acting)

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Indications
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Muscle spasm associated with acute painful musculoskeletal conditions (with rest and physical therapy).

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Action
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Skeletal muscle relaxation, probably as a result of CNS depression. Therapeutic Effects: Skeletal muscle relaxation.

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Adverse Reactions/Side Effects
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CNS: drowsiness, dizziness, confusion, headache, irritability, nervousness. GI: nausea, anorexia, dry mouth, GI upset, vomiting. GU: urinary retention.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess patient's pain, stiffness, and ROM to help document antispasm effects.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Be alert for confusion, irritability nervousness, or other alterations in mental status (see Appendix D). Notify physician promptly if these symptoms become problematic.

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Interventions
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  • Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and wean patient off muscle relaxants as soon as possible.

  • Help patient explore other nonpharmacologic methods to reduce chronic pain, such as relaxation techniques, exercise, counseling, and so forth.

  • Implement fall-prevention strategies, especially if balance is impaired (See Appendix E).

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Patient/Client-Related Instruction
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  • Inform patient that long-term use can cause tolerance and dependence; encourage adherence to physical therapy so that drug therapy can be discontinued as soon as possible.

  • Inform patient that this drug may cause severe drowsiness, dizziness, and reduced psychomotor skills. Patients should avoid driving or other activities that require concentration and fast reactions.

  • Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

  • Warn patient about anticholinergic effects such as dry mouth, constipation, urinary retention, sedation, and weakness; anticholinergic effects are often more severe in older adults.

  • Instruct patient and family/caregivers to report other GI problems such as prolonged or severe nausea, vomiting, indigestion, or loss of appetite.

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Pharmacokinetics
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Absorption: Well absorbed following oral administration.

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Distribution: Unknown.

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Metabolism and Excretion: Mostly metabolized by the liver; metabolites excreted in urine.

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Half-life: 2–3 hr.

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TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION
PO 1 hr 2 hr 4–6 hr

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Significant hepatic/renal impairment; History of drug-induced hemolytic anemia or other anemia.

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Use Cautiously in: History of seizures; Geri: Appears on Beers' list. Poorly tolerated due to anticholinergic effects; Pregnancy, lactation, or children ≤12 yr (safety not established; use only in pregnancy/lactation if possible benefits outweigh potential risks).

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