Therapeutic: skeletal muscle relaxants (centrally acting)
Muscle spasm associated with acute painful musculoskeletal conditions (with rest and physical therapy).
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.
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).
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.
Absorption: Well absorbed following oral administration.
Metabolism and Excretion: Mostly metabolized by the liver; metabolites excreted in urine.
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 in pregnancy/lactation if possible benefits outweigh potential risks).