Tizanidine Interactions: Zanaflex And Alcohol Or Drugs

Last Updated: February 19, 2020

Tizanidine interactions are possible with other drugs, vitamins, or even herbs. These will change the way Zanaflex works, which can render the medicine ineffective and is dangerous to health.

Tizanidine and Alcohol Interaction

Drinking while taking tizanidine can increase risks of serious side effects, including extreme drowsiness or sedation, confusion, and difficulty concentrating. Older people may also experience impairment in judgment, thinking, and motor coordination.

These side effects are most likely to occur at the beginning of the treatment, following an increase in dosage, or when treatment is restarted after an interruption.
Zanaflex and alcohol also depress the body in similar ways, and their combination can lead to shallow or slowed breathing. This increases one’s risk of brain damage.
Patients should be cautious when driving or operating machinery to avoid accidents and use caution when getting up from a sitting or lying position. One must avoid drinking while on Zanaflex treatment.

Tizanidine and Ibuprofen Interaction

Other than a possible additive CNS depression, no other serious drug interactions were found between ibuprofen and tizanidine. They are being used as a combination therapy for the treatment of low-back pain.

Zanaflex and Tramadol Interaction

While tizanidine and tramadol belong to different drug classes, they share a few side effects. Combining these two can increase one’s risk of anxiety, nervousness, drowsiness, dizziness, stomach pain, constipation, diarrhea, vomiting, fever, and skin rash.

tizanidine drug interactions

Drugs That Should Not Be Used With Zanaflex

Because of tizanidine MOA, a central-acting alpha2-adrenergic agonist, it can cause significant hypotension in some patients, especially with higher doses. For this reason, the following drugs should not be taken with Zanaflex.


Tizanidine and Cipro combination may cause very low blood pressure. There is also an increased risk of extreme drowsiness, bradycardia, and decreased muscle control.


Another severe Zanaflex interactions involve the use of fluvoxamine. When used together, one may suffer from tizanidine toxicity, including hypotension, sedation, and bradycardia. Fluvoxamine can increase Zanaflex’s maximum concentration and half-life by as much as 12-fold and 3-fold, respectively.


Tizanidine is metabolized by CYP1A2. The use of thiabendazole, a potent CYP1A2 hepatic enzyme inhibitor, can increase the concentration of Zanaflex. Aside from the usual hypotension and drowsiness, one is at risk of psychomotor impairment.
Other alpha-2 agonist medications that also cause a significant drop in blood pressure when used with Zanaflex include:

  • Clonidine
  • Methyldopa
  • Guanfacine
  • Guanabenz

Serious Interactions with Zanaflex That Require Medical Supervision

Hydrocodone, Codeine, Alfentanil, and Opium

Concomitant use of tizanidine and hydrocodone may cause respiratory depression, hypotension, profound sedation, and even death. The same interactions are observed with codeine, alfentanil, and opium. These combinations, with the approval of a physician, are only given to patients for whom alternative treatment options are inadequate.


Mixing tizanidine with gabapentin can cause additive CNS depression. Patients should be monitored for symptoms of sedation and somnolence. Gabapentin should be initiated at the lowest recommended dose. Proper education about the risks and symptoms of excessive CNS depression and monitoring is necessary.

tizanidine and gabapentin

Amiodarone and Cimetidine

Cimetidine is yet another potent CYP1A2 inhibitor that can cause a substantial increase in Zanaflex concentration. The same side effect is observed with amiodarone. There is an increased risk of hypotension, bradycardia, and excessive drowsiness. Doctors may initiate the use of 2 mg tizanidine depending on clinical response, but close monitoring should be done regularly.

Oral Contraceptives

Oral contraceptives can also increase Zanaflex blood concentrations. The clearance of Zanaflex is 50% lower in women who take combined hormonal OCs with tizanidine. Increased hypotensive effects may occur. If concurrent use cannot be avoided, doctors should start with a 2 mg dose with close monitoring.


Tizanidine is a sensitive CYP1A2 substrate. Givosiran may also decrease hepatic CYP1A2 enzyme activity, which, in turn, can increase tizanidine hydrochloride side effects. If use is necessary, decreasing the Zanaflex dose must be considered.

Drugs That Can Cause Some Risks When Taken with Zanaflex

Clonazepam and Xanax

Concurrent use of tizanidine and clonazepam can cause additive CNS depression. The same is true with Xanax.

bottle with pills on a table

Acebutolol and Triamterene

Zanaflex, when used together with anti-hypertensive agents, can result in significant hypotension.


Aliskiren may enhance the effects of Zanaflex on blood pressure if given concomitantly. Blood pressure and electrolytes should be monitored regularly.



CNS depressants like Zanaflex can potentiate the effects of dronabinol on respiratory depression.


Use caution when administering teriflunomide and Zanaflex concurrently. Teriflunomide is a weak inducer of CYP1A2, which may decrease tizanidine exposure and cause a reduction in efficacy.

Get Professional Help In Case of Tizanidine Addiction

Can tizanidine get one high? Evidence shows that tizanidine is very to have psychic-dependence potential, but there is a possibility of the drug being abused.
Is tizanidine a narcotic? Though Zanaflex can be addictive, it is not a narcotic. It is a muscle relaxant that has a short duration of effect. It peaks within 1-2 hours and starts wearing off within 3-6 hours. For this reason, Zanaflex may be taken as needed, hence often being abused.
Addiction occurs when one exceeds a daily average dose of 20-36 mg. Withdrawal symptoms, such as anxiety, hypertension, tachycardia, tremor, and hypertonia, start to show up after drug cessation. Healthcare professionals can help with the management of withdrawal symptoms.
Will tizanidine show up on a drug test? Yes. One can confirm the abuse of tizanidine via a urine screen test. The drug is traceable in the urine for up to 2 days.
Medical help is available for everyone who is addicted to tizanidine. Detox is best done in a reputable addiction rehab center.

Page Sources

  1. Berry H, Hutchinson DR. Tizanidine and ibuprofen in acute low-back pain: results of a double-blind multicentre study in general practice.J Int Med Res. 1988 Mar-Apr;16(2):83-91. https://www.ncbi.nlm.nih.gov/pubmed/2967781
  2. Suárez-Lledó A, Padullés A, Lozano T, Cobo-Sacristán S, Colls M1, Jódar R. Management of Tizanidine Withdrawal Syndrome: A Case Report. Clin Med Insights Case Rep. 2018. https://www.ncbi.nlm.nih.gov/pubmed/29467587

Published on: February 19th, 2020

Updated on: February 19th, 2020


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