Frequently Asked Questions About Muscle Relaxers

Muscle relaxers are formulations that lower the tone of the skeletal muscles. They diminish the motor activity up to complete immobilization. It is needed in a wide range of diseases, disorders, traumas in which muscle spasm occurs.

This class of the formulations is divided into two groups - neuromuscular blockers and spasmolytics. Neuromuscular blockers block the transmission at the neuromuscular junction, inducing immobility of the impacted muscles. Spasmolytics or antispasmodics are medicines that eliminate muscle spasms.

The medicines from the first group are split into relaxants are divided into antidepolarizers (non-polarizing), depolarizers, and "mixed type".
– Antidepolarizing or nondepolarizing muscle relaxants paralyze neuromuscular transmission, reducing the sensitivity of the n-cholinergic receptors of the synaptic region to acetylcholine, eliminating the possibility of polarization of the endplate and the excitation of muscle fibers. These include d-tubocurarine, diplacin dichloride, pipecuronium bromide, atracuria besilate, and others. Their antagonists are anticholinesterase substances: inhibition of cholinesterase leads to an accumulation of acetylcholine in the synapse region, which, at elevated concentrations, displaces curariform-like substances from n-cholinergic receptors and restores neuromuscular conductivity.
– Depolarizers relax the muscles, causing, on the contrary, resistant depolarization of the end plate, making it (like excessive amounts of acetylcholine) immune to new impulses and ultimately also disrupting the conduction of excitation from nerve to muscle. Preparations of this group are relatively rapidly hydrolyzed by cholinesterase and give a short-term effect when administered once; of course, anticholinesterase agents enhance their action. The main representative of this group is suxamethonium iodide.
– Individual muscle relaxants can have a mixed effect - anti-depolarizing and depolarizing.

These muscles relaxers are used for immobility of patients during surgical operations or other procedures that require muscle relaxations.

The relaxants that can be prescribed for the use even at home are antispasmodics or spasmolytics. They relieve spasms of smooth muscles of internal organs, vessels, etc., that violate various functions of organs. Antispasmodics are used in various diseases. Their effect is due to anticholinergic action, i.e. the blocking of the neurotransmitter acetylcholine in the nervous system.

The use of paralyzing muscle relaxers is needed in:
1. Providing conditions for tracheal intubation;
2. Ensuring muscle relaxation during surgery to create optimal conditions for the surgical team without excessive doses of drugs for general anesthesia, as well as the need for muscle relaxation with some diagnostic procedures performed under general anesthesia (for example, bronchoscopy);
3. Suppression of spontaneous breathing for the purpose of mechanical ventilation;
4. Elimination of convulsive syndrome with the ineffectiveness of anticonvulsant drugs;
5. Blockade of protective reactions to cold in the form of muscle tremors and hypertonicity of muscles during artificial hypothermia;
6. Muscle relaxation at reposition of bone fragments and reduction of dislocations in the joints, where there are powerful muscle arrays.

The uses that imply the intake or oral used at home muscle relaxers include:
– Urinary incontinence (for instance, Ditropan (Oxybutynin) by Cipla);
– Neurogenic bladder dysfunction;
– Frequent urination in unstable bladder function;
– Nocturnal enuresis (bedwetting);
– Muscle spasticity;
– Multiple sclerosis;
– Spinal cord injuries;
– Cerebral stroke;
– Cerebral palsy;
– Head injury;
– Pathologically elevated muscle tone;
– Muscle spasms;
– Myelopathy;
– Spondylosis (for instance, Zanaflex (Tizanidine) by Sun Pharma);
– Arthrosis;
– After an orthopedic surgery;
– Atherosclerosis;
– Diabetic angiopathy;
– Thromboangiitis obliterans;
– Raynaud’s disease;
– Painful muscle spasms;
– Osteochondrosis;
– Syringomyelia;
– Hemiplegia;
– Cervical and lumbar syndromes;
– Spasticity and pain caused by neurological diseases;
– Degenerative diseases of the spinal cord;
– Cerebral circulatory disorders;
– Stroke;
– Seizures of central origin;
– Spasms in the lower back;
– Bronchial asthma.

Before you buy any muscle relaxer even though you can do so without having a prescription from a doctor, we highly advise you to get a proper diagnosis and follow a specialist’s recommendations. It is important to do so first of all because not all of them are used for the listed conditions. Some are used for incontinence and others for spinal cord spasms. Besides, some of them are more effective for certain conditions than others and only a doctor chooses the right therapy.

For the majority of conditions for which muscle relaxers are used, the course duration should be quite short because they have a symptoms-relief effect rather that therapeutic. To lower the pains associated with muscle spasms, it is much more preferable to find and eliminate the reason of the spasm.

The time for which medications are prescribed usually is from 5 days to 30 days. But you should consult a specialist who knows your medical history and can assess the condition in person.

This depends on the medication you plan to use but there also some common prohibitions such as:
– Individual intolerability of the pills’ components. It can be manifested as swelling of the face, tongue or lips, skin rash and itching, and even anaphylaxis;
– It is contraindicated for most muscle relaxers to be used along with MAO inhibitors because the combination can be fatal. (Read the instruction for a certain medication before using it as it may be contraindicated to be used with other medicines that you use besides MAO inhibitors);
– During the recovery phase after acute myocardial infarction and in the presence of cardiac arrhythmias and conduction, including blockade, or congestive heart failure;
– Hyperthyroidism;
– Severe liver or kidney dysfunction;
– Myasthenia gravis;
– First trimester of pregnancy (sometimes, during the whole pregnancy);
– Lactation period;
– Some muscle relaxers are contraindicated to small children.

The adverse effects greatly depend on the disease for which muscle relaxers are used and the used medication. Here we list some of the most common adverse reactions that can be associated with the formulations use but it doesn’t mean that you will develop even a single one of them:
– Dry mouth;
– Dizziness;
– Fatigue;
– Constipation;
– Nausea;
– Dyspepsia and drowsiness;
– Low blood pressure;
– Disorders of the gastrointestinal tract and elevated serum transaminase levels.

These disorders and symptoms can occur at the beginning of the therapy and usually go away within a couple of days.

Other possible but more rare adverse reactions include:
– Common disorders: fainting, malaise, chest pain, swelling;
– Cardiovascular system: tachycardia, arrhythmia, vasodilation, palpitations, myocardial infarction, blockade of cardiac conduction, stroke;
– On the part of the digestive system: vomiting, anorexia, diarrhea, abdominal pain, gastritis, thirst, flatulence, tongue edema, abnormal liver function and rare cases of hepatitis, jaundice and cholestasis, paralytic intestinal obstruction, discoloration of the tongue, stomatitis, edema of the parotid salivary gland.

The majority of medications are contraindicated during pregnancy and muscle relaxers are not an exception. However, in some cases when the risks are considered lower than the expected benefits, a doctor can appoint the use of the muscle relaxers for pregnant women. But you should never use them without consulting a doctor. First of all, because not all muscle relaxers can be used during pregnancy, and secondly because those that are allowed must not be used during the first trimester of pregnancy.

Yes, muscle relaxers are commonly prescribed for the symptomatic treatment of backaches associated with muscle spasms. For instance, in sedentary lifestyle it is quite common for people to get their back nerves compressed by the muscles in an incautious move. There are many other cases when back pain can be relieved by muscle relaxers including such serious chronic diseases as spondylitis. But it’s always better to get diagnosed and follow your doctor’s instructions on the muscle relaxers use.

No, they shouldn’t be used to prevent back pain. The effect of muscle relaxers is needed when the spasm had already occurred and caused pain. They do not eliminate the cause for the spasms and pains. To prevent back pain it is important to apply a complex approach of therapy including, for instance, the use of NSAIDs, physiotherapy, massage, gymnastics for the back muscles strengthening, and so on.