Tizanidine Online

How and where to order Tizanidine Hydrochloride (Zanaflex) 2 mg, 4 mg capsules or tablets online on Marc S. Goldman MD website:

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Forms:	tablets or capsules 2 mg, 4 mg
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Type:	Tizanidine HCl brand, Zanaflex generic
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Indications and usage:

Zanaflex (Tizanidine Hydrochloride) is a central alpha-2-adrenergic agonists indicated for the management of back pain and other forms of spasticity. Because of the short duration of therapeutic effect, treatment with this medication should be reserved for those daily activities and times when relief of spasticity is most important.

Dosage and administration:

Recommended starting dose of Zanaflex: 2 mg; dose can be repeated at 6 to 8 hour intervals, up to a maximum of 3 doses in 24 hours.

Dosage can be increased by 2 mg to 4 mg per dose, with 1 to 4 days between increases; total daily dose should not exceed 36 mg.

Tizanidine pharmacokinetics differs between tablets and capsules, and when taken with or without food. These differences could result in a change in tolerability and control of symptoms.

To discontinue this medicine, decrease dose slowly to minimize the risk of withdrawal and rebound hypertension, tachycardia, and hypertonia.

Dosage forms and strengt:

Zanaflex (Tizanidine HCl) capsules 2 mg, 4 mg, 6 mg.

Zanaflex (Tizanidine HCl) tablets 4 mg.

Contraindications:

Concomitant use of tizanidine with potent inhibitors of CYP1A2, such as fluvoxamine or ciprofloxacin.

Warnings and precautions:

Hypotension: monitor for signs and symptoms of hypotension, in particular in patients receiving concurrent antihypertensives; Zanaflex should not be used with other alpha2-adrenergic agonists.

Risk of liver injury: monitor ALTs; discontinue tizanidine if liver injury occurs.

Sedation: this drug may interfere with everyday activities; sedative effects of Zanaflex, alcohol, and other CNS depressants are additive.

Hallucinations: consider discontinuation of Zanaflex.

Less potent inhibitors of CYP1A2: may cause hypotension, bradycardia, or excessive drowsiness, use caution if Zanaflex is used with less potent inhibitors of CYP1A2, e.g., zileuton, other fluoroquinolones, antiarrythmics, cimetidine, famotidine, oral contraceptives, acyclovir, and ticlopidine.

Renal impairment (creatinine clearance < 25 mL/min): use Tizanidine Hydrochloride (Zanaflex) with caution, and monitor closely for dry mouth, somnolence, asthenia and dizziness as indicators of potential overdose.

Overdosage:

A review of the safety surveillance database revealed cases of intentional and accidental Tizanidine (Zanaflex) capsules or tablets overdose. Some of the cases resulted in fatality and many of the intentional overdoses were with multiple drugs including CNS depressants. The clinical manifestations of tizanidine overdose were consistent with its known pharmacology. In the majority of cases a decrease in sensorium was observed including lethargy, somnolence, confusion and coma. Depressed cardiac function is also observed including most often bradycardia and hypotension. Respiratory depression is another common feature of tizanidine overdose.

Should overdose occur, basic steps to ensure the adequacy of an airway and the monitoring of cardiovascular and respiratory systems should be undertaken. Tizanidine is a lipid-soluble drug, which is only slightly soluble in water and methanol. Therefore, dialysis is not likely to be an efficient method of removing drug from the body. In general, symptoms resolve within one to three days following discontinuation of tizanidine and administration of appropriate therapy. Due to the similar mechanism of action, symptoms and management of tizanidine overdose are similar to that following clonidine overdose. For the most recent information concerning the management of overdose, contact a poison control center.

Adverse reactions, side effects:

The most common adverse reactions (greater than 2% of 264 patients taking tizanidine and greater than in placebo-treated patients in three multiple dose, placebo-controlled studies) were dry mouth, somnolence, asthenia, dizziness, urinary tract infection, constipation, liver function tests abnormal, vomiting, speech disorder, amblyopia, urinary frequency, flu syndrome, SGPT/ALT increased, dyskinesia, nervousness, pharyngitis, and rhinitis.

To report suspected side effects of Zanaflex (Tizanidine HCl) pills contact Acorda Therapeutics pharmaceutical company, or your local FDA.

Drug abuse and dependence:

Abuse

Abuse potential was not evaluated in human studies. Rats were able to distinguish tizanidine from saline in a standard discrimination paradigm, after training, but failed to generalize the effects of morphine, cocaine, diazepam, or phenobarbital to tizanidine.

Dependence

Tizanidine (Zanaflex) is closely related to clonidine, which is often abused in combination with narcotics and is known to cause symptoms of rebound upon abrupt withdrawal. Three cases of rebound symptoms on sudden withdrawal of tizanidine have been reported. The case reports suggest that these patients were also misusing narcotics. Withdrawal symptoms included hypertension, tachycardia, hypertonia, tremor, and anxiety. Withdrawal symptoms are more likely to occur in cases where high doses are used, especially for prolonged periods, or with concomitant use of narcotics. If therapy needs to be discontinued, the dose should be decreased slowly to minimize the risk of withdrawal symptoms.

Use in specific populations:

Pregnancy: based on animal data, may cause fetal harm.

Nursing mothers: it is not known whether this drug is excreted in human milk.

Pediatric use: safety and effectiveness of Zanaflex in pediatric patients have not been established.

Geriatric use: this medication should be used with caution in elderly patients because clearance is decreased four-fold.

Impaired renal function: the risk of adverse reactions to this drug may be greater in patients with impaired renal function.

Impaired hepatic function: the influence of hepatic impairment on the pharmacokinetics of tizanidine has not been evaluated.

Patient counseling information:

Serious drug interactions

Advise patients they should not take Zanaflex (Tizanidine) tablets and capsules as a muscle relaxant if they are taking fluvoxamine or ciprofloxacin because of the increased risk of serious adverse reactions including severe lowering of blood pressure and sedation. Instruct patients to inform their physicians or pharmacists when they start or stop taking any medication because of the risks associated with interaction between Zanaflex and other medicines.

Zanaflex dosing

Tell patients to take this medication exactly as prescribed (consistently either with or without food) and not to switch between tablets and capsules. Inform patients that they should not take more Zanaflex than prescribed because of the risk of adverse events at single doses greater than 8 mg or total daily doses greater than 36 mg. Tell patients that they should not suddenly discontinue Zanaflex, because rebound hypertension and tachycardia may occur.

Effects of tizanidine

Warn patients that they may experience hypotension and to be careful when changing from a lying or sitting to a standing position. Tell patients that Zanaflex may cause them to become sedated or somnolent and they should be careful when performing activities that require alertness, such as driving a vehicle or operating machinery. Tell patients that the sedation may be additive when Zanaflex is taken in conjunction with drugs (baclofen, benzodiazepines) or substances (e.g., alcohol) that act as CNS depressants. Remind patients that if they depend on their spasticity to sustain posture and balance in locomotion, or whenever spasticity is utilized to obtain increased function, that Zanaflex decreases spasticity and caution should be used.

Where to buy tizanidine online:

To purchase Zanaflex (Tizanidine HCl) pills from reliable online pharmacies and drugstores at low prices please use resources described above on this webpage.

Here is a list of popular medications containing tizanidine as a main active pharmaceutical ingredient; their trade names, forms, doses, companies - manufacturers, distributors, suppliers, researchers and developers:

Trade name of the drug	Pharmaceutical forms and doses	Companies
Sirdalud	Tablets; Oral; 1 mg, 2 mg, 4 mg, 6 mg	Novartis Dr. Reddy's Laboratories Sandoz Sanofi
Ternelin	Granules; Oral; 2 mg / g Tablets; Oral; 1 mg, 2 mg, 4 mg	Novartis Sandoz
Tizan	Tablets; Oral; 2 mg, 4 mg	Sun Pharmaceutical Industries
Tizanidin-Teva	Tablets; Oral; 2 mg, 4 mg, 6 mg	Teva
Tizanor	Tablets; Oral; 2 mg, 4 mg	Orion Pharma
Zanaflex	Capsules; Oral; 2 mg, 4 mg, 6 mg Tablets; Oral; 2 mg, 4 mg	Acorda Therapeutics Cephalon Elan Pharmaceuticals Paladin Laboratories Shire Squire Pharmaceuticals Zeneus Pharma