Flexeril vs. Skelaxin

See how Flexeril and Skelaxin compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Flexeril and Skelaxin are both prescription muscle relaxants used short-term with rest and physical therapy for acute muscle spasm, but they work differently and are dosed differently.

  • Flexeril causes drowsiness in up to 39% of patients and dry mouth in up to 27%, while Skelaxin's label lists similar side effects without specific rates.

  • Flexeril is limited to 2 to 3 weeks of use and has heart-related contraindications, while Skelaxin has fewer cardiac restrictions but costs significantly more per month.

Flexeril vs. Skelaxin Drug Summary

Flexeril

Flexeril (cyclobenzaprine) is a tricyclic-related skeletal muscle relaxant used short-term, alongside rest and physical therapy, to relieve muscle spasm from acute musculoskeletal injuries. It's taken as an oral tablet three times a day, usually for no more than 2 to 3 weeks.

Skelaxin

Skelaxin (metaxalone) is a skeletal muscle relaxant used, like Flexeril, alongside rest and physical therapy for acute painful muscle spasm. It's taken as an oral tablet three to four times a day and is approved for adults and adolescents 13 and older.

Flexeril vs. Skelaxin Side Effects

Flexeril

Most common
Drowsiness (up to 39%)
Dizziness (up to 11%)
Headache (up to 5%)
Nausea (1% to 3%)

Skelaxin

Most common
Drowsiness (rate not specified)
Dizziness (rate not specified)
Headache (rate not specified)
Nausea (rate not specified)

Flexeril vs. Skelaxin Dosage

Flexeril

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 5 mg three times daily At the start
Maximum dose 10 mg three times daily If needed
Dose changes 1 increase As tolerated

Skelaxin

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 800 mg 3-4 times daily At the start
Maximum dose 800 mg 3-4 times daily Same as starting
Dose changes None Fixed dose

Flexeril vs. Skelaxin Indications

Flexeril

Flexeril is FDA-approved only as an adjunct to rest and physical therapy for muscle spasm caused by acute musculoskeletal conditions, not for spasticity from brain or spinal cord disease. It's also used off-label for fibromyalgia pain and sleep symptoms, though that isn't an FDA-approved use.

  • Relief of muscle spasm from acute musculoskeletal injury

  • Used with rest and physical therapy, not alone

  • Off-label: fibromyalgia pain and sleep symptoms

  • Not effective for spasticity from CNS conditions

Skelaxin

Skelaxin is FDA-approved as an adjunct to rest and physical therapy for acute, painful musculoskeletal conditions in adults and adolescents 13 and older. It has no widely recognized off-label uses and isn't approved for children 12 and under.

  • Relief of acute painful musculoskeletal conditions

  • Used with rest and physical therapy, not alone

  • Approved for adults and adolescents 13 and older

  • Not approved for children 12 and under

Flexeril vs. Skelaxin Pros and Cons

Flexeril

Cyclobenzaprine has been used since 1977 and is now only available as a generic, keeping its cost relatively low. It causes more drowsiness and dry mouth than many alternatives and carries specific heart-related contraindications that limit who can take it.

Pros

  • Available only as low-cost generic

  • Decades of clinical use and familiarity

  • Simple three-times-daily dosing

  • Roughly $20 to $55 per month, well below Skelaxin

Cons

  • Drowsiness in up to 39% of patients

  • Dry mouth in up to 27% of patients

  • Contraindicated with MAO inhibitors and several heart conditions

  • Not recommended for use beyond 2 to 3 weeks

Skelaxin

Metaxalone has no boxed warning and fewer cardiac contraindications than cyclobenzaprine, but its absorption depends heavily on whether it's taken with a high-fat meal. It's also significantly more expensive, with list prices several times higher than Flexeril's generic.

Pros

  • No boxed warning on its label

  • Fewer cardiac contraindications than Flexeril

  • Approved for adolescents 13 and older

  • Less anticholinergic effect, no reported dry mouth

Cons

  • Absorption changes significantly with food timing

  • Roughly $110 to $265 per month, well above Flexeril

  • Contraindicated in severe renal or hepatic impairment

  • Serotonin syndrome risk with other serotonergic drugs

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