Skelaxin vs. Tizanidine

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

Key Takeaways

  • Skelaxin is FDA-approved for short-term acute muscle pain, while tizanidine is approved for spasticity and often used off-label for chronic pain conditions.

  • Both drugs cause drowsiness and dizziness, but tizanidine also carries a higher risk of dry mouth and low blood pressure that Skelaxin does not share.

  • Tizanidine requires a gradual dose increase and periodic liver monitoring, while Skelaxin is typically started at a fixed dose without titration.

Skelaxin vs. Tizanidine Drug Summary

Skelaxin

Skelaxin (metaxalone) is a skeletal muscle relaxant used alongside rest and physical therapy for acute, painful muscle injuries. It's taken as an oral tablet, usually 800 mg three to four times a day. It has been available since 1962, and taking it with a fatty meal significantly increases how much the body absorbs.

Tizanidine

Tizanidine is a centrally acting alpha-2 agonist FDA-approved to manage muscle spasticity from conditions like multiple sclerosis or spinal cord injury. It's taken as an oral tablet or capsule, starting at a low dose and increasing gradually every few days up to a maximum of 36 mg per day. It's also used off-label for chronic pain and migraine prevention, though these uses aren't FDA-approved.

Skelaxin vs. Tizanidine Side Effects

Skelaxin

Most common
Drowsiness (rate not specified)
Dizziness (rate not specified)
Headache (rate not specified)
Nervousness/irritability (rate not specified)

Tizanidine

Most common
Somnolence/sedation (>10%)
Dizziness (>10%)
Dry mouth (>10%)
Urinary tract infection (>2%)

Skelaxin vs. Tizanidine Dosage

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

Tizanidine

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2 mg every 6-8 hrs At the start
Maximum dose Increase 2-4 mg/dose If needed
Dose changes 1 increase As tolerated

Skelaxin vs. Tizanidine Indications

Skelaxin

Skelaxin is approved as an add-on treatment, alongside rest and physical therapy, for acute painful musculoskeletal conditions like muscle strains and sprains. It's approved for adults and teens 13 and older, but not for chronic pain or younger children.

  • Treats acute muscle strains and sprains

  • Used alongside rest and physical therapy

  • Approved for adults and teens 13 and up

  • Not approved for chronic musculoskeletal pain

Tizanidine

Tizanidine is FDA-approved specifically to manage spasticity, the muscle stiffness and spasms seen in conditions like multiple sclerosis or spinal cord injury. Doctors also prescribe it off-label for chronic low back pain, migraine prevention, and insomnia, though these uses aren't FDA-approved.

  • Treats spasticity from MS or spinal cord injury

  • Off-label for chronic low back/myofascial pain

  • Off-label for migraine prevention

  • Off-label for insomnia

Skelaxin vs. Tizanidine Pros and Cons

Skelaxin

Skelaxin has a long track record since 1962 and avoids some of the drug interaction and withdrawal concerns seen with tizanidine. It costs more out of pocket, and how much the body absorbs can shift depending on whether it's taken with food.

Pros

  • No boxed warning and no withdrawal syndrome on stopping

  • No contraindication with common antibiotics

  • Long-standing safety record since its 1962 approval

  • FDA-approved specifically for acute muscle injury pain

Cons

  • Costs more: roughly $110 to $265 per month without insurance

  • Absorption changes significantly depending on food intake

  • Not approved for spasticity or chronic pain conditions

  • Requires dosing three to four times a day

Tizanidine

Tizanidine costs far less out of pocket and can be titrated to match how severe a person's spasticity is. It requires more monitoring, though, including liver function checks and caution around abrupt discontinuation.

Pros

  • Costs less: roughly $15 to $50 per month without insurance

  • Flexible titration allows dosing tailored to severity

  • Available in both tablet and capsule forms

  • Long clinical experience supports off-label pain uses

Cons

  • Requires periodic liver function monitoring

  • Contraindicated with fluvoxamine and ciprofloxacin

  • Risk of rebound hypertension if stopped abruptly

  • Off-label pain and migraine uses lack FDA approval

Common Symptoms and Related Diseases You Can Explore

Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.