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INTRODUCTION

metaxalone (me-tax-a-lone)

Skelaxin

Classification

Therapeutic: skeletal muscle relaxants (centrally acting)

Indications

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

Action

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

Adverse Reactions/Side Effects

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

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

  • 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.

Interventions

  • 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).

Patient/Client-Related Instruction

  • 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.

Pharmacokinetics

Absorption: Well absorbed following oral administration.

Distribution: Unknown.

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

Half-life: 2–3 hr.

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TIME/ACTION PROFILE

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

Contraindications/Precautions

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

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 ...

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