Microsoft word - wspa-wa rx cns muscle relaxants pearls.doc
CNS Muscle Relaxants Clinical Pearls for the Washington Rx Therapeutic Interchange Program (TIP) Steve Riddle, BS Pharm, BCPS
Background In 2003, the Washington State Pharmacy and Therapeutics Committee (P&T), the agency directors of the Department of Social and Health Services-Medical Assistance Administration (DSHS-MAA), Labor and Industries (L&I), and the Health Care Authority-Uniform Medical Plan (UMP) declared baclofen, chlorzoxaxone, cyclobenzaprine and methocarbamol to be the “preferred” CNS muscle relaxants for patients covered by their prescription insurance. Patients currently using “non- preferred” agents” must be evaluated for conversion to a preferred agent. Furthermore, patients presenting with prescriptions for non-preferred agents from “endorsing practitioners” (i.e., providers that have signed the TIP agreement) may be automatically converted to preferred agents by pharmacists once this program is operational. Purpose The purpose of this document is to inform pharmacists of the clinical, safety and cost rationale for these policy changes and to optimize their ability to assure safe and effective conversion of patients to the appropriate agents. Washington State Evidence Based Preferred Drug ListPreferred CNS Muscle Relaxants are: Baclofen (generic) Chlorzoxazone (generic) Cyclobenzaprine (generic) Methocarbamol (generic)
Overview Skeletal muscle relaxants are a mixed group of medications that are used to treat two different types of conditions:
1) Musculo-skeletal conditions causing tenderness and muscle spasms include fibromyalgia, tension headaches, neck
2) Spasticity, a clinical condition characterized by increased muscle tone from such neurological conditions as
Currently Available Agents and Muscle Relaxant Applications For Muscle Spasm: For Spasticity
*Washington State Evidence Based Preferred Drug List Agents Clinical Efficacy Summary
All muscle relaxants are effective for muscle spasm except for metaxalone, which was not more effective than
Baclofen, dantrolene, and tizanidine were as effective as diazepam for spasticity.
Diazepam was not studied in this group as it is used primarily for symptoms of anxiety.
Cyclobenzaprine has the largest body of evidence supporting its effectiveness. Safety Comparisons
Carisoprodol is a controlled substance in Oregon because of its potential for addiction. Dantrolene is associated with rare but fatal liver toxicity. Because of the potential for adverse effects, use of tizanidine requires that the patient’s liver function be
Evidence-Based Drug Reviews are available at http://www.oregonrx.org
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