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
Tizanidine
Skelaxin vs. Tizanidine Dosage
Skelaxin
Tizanidine
| 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 |
| 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
| 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
| 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
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