Expert Guidance: Tizanidine and Alcohol and Drug Interactions

Last Updated: May 17, 2024

David Levin Reviewed by David Levin
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Muscle spasms can be a disruptive movement for those who suffer from them. While several medications aim to provide relief, Tizanidine stands out as a frequently prescribed option.

Navigating its use requires delving beyond its therapeutic properties. Taking Zanaflex with other substances like Fluvoxamine may lead to different reactions that may adversely affect a person’s health.

Although effective in alleviating muscle-related symptoms associated with conditions like multiple sclerosis, spinal cord injuries and certain neurological disorders, it is crucial to understand the potential risks and repercussions associated with the concurrent use of Tizanidine and alcohol and other possible drug interactions.

Why You Can’t Take Alcohol and Tizanidine Together

Significant clinical reasons show evidence of why this interaction can be dangerous. Among the evidences, we have:

Central Nervous System (CNS) Depression

The central nervous system (CNS), comprised of the brain and spinal cord, plays a fundamental role in regulating various bodily functions, including cognition, coordination and motor activity.

CNS depression refers to decreased neuronal activity in the central nervous system. When Tizanidine and alcohol are taken concurrently, their respective CNS depressant effects are additive, if not synergistic. The combined depressant action manifests itself as increased sedation, drowsiness and compromised cognitive and motor functions.

Risk of Drowsiness and Impaired Coordination

Drowsiness is a well-documented side effect of Tizanidine, commonly reported by individuals using the medication.

Alcohol and Tizanidine can significantly intensify this side effect. The impaired coordination and slowed reaction times associated with substances can compromise an individual’s ability to perform tasks that require mental alertness.

Liver Function Concerns

Both substances are metabolized in the liver. Combining Tizanidine and alcohol may place additional stress on the liver, potentially leading to hepatotoxicity or liver damage over time.

Patients with pre-existing liver conditions or those taking other medications metabolized in the liver may be particularly vulnerable.

Top 11 Drug Interactions to Avoid with Tizanidine

Severe drug interactions signify potentially dangerous reactions when Tizanidine is combined with certain medications. These interactions can lead to adverse effects, compromising health and safety. Here are the top severe Tizandine drug interactions:

CYP1A2 Inhibitors (Fluvoxamine, Ciprofloxacin):

Tizanidine is primarily metabolized by the CYP1A2, an enzyme involved in metabolizing a few drugs and caffeine.

Tizanidine relies heavily on this enzyme for its biotransformation, allowing for its elimination from the body.

When Fluvoxamine, an antidepressant, or Ciprofloxacin, a widely used antibiotic, are used concurrently like Tizanidine and alcohol, they work as potent CYP1A2 inhibitors. Their inhibitory action compromises the liver’s ability to metabolize Tizanidine efficiently.

Fluvoxamine or Ciprofloxacin also have adverse effects, increasing Zanaflex’s pharmacological effect.

  • The combination of high Tizanidine levels and sedative effects put patients at risk of low blood pressure.
  • High Tizanidine levels and sedation can cause respiratory depression.
  • The effects of intensified sedation, hypotension and respiratory depression can lead to CNS depression.

Central Nervous System Depressants (Opioids)

Tizanidine and opioids exert their effects on the CNS by depressing neuronal activity.

Tizanidine incidentally lowers blood pressure. Clonidine primarily targets blood pressure regulation by reducing sympathetic outflow. Combining alcohol and Tizanidine or other CNS depressants, especially opioids, amplifies sedative effects.

The synergistic impact on the CNS poses a severe threat and requires prompt medical intervention.

  • Concurrent use of Tizanidine and alcohol causes mental cloudiness and reduced alertness.
  • The combination of Tizanidine and opioids can result in an extreme state of drowsiness.
  • Tizanidine and opioids increase overdose risk due to prolonged respiratory depression and failure.

Moderate Tizanidine Drug Interactions

Moderate Tizanidine drug interactions indicate that combining Tizanidine with certain medications may lead to noticeable effects, although not necessarily severe. These interactions may require adjustments in dosage or careful monitoring. Here are the top moderate Tizandine drug interactions:

Antihypertensive Medications (Clonidine, Thiabendazole, Methyldopa)

Combination of Clonidine with Zanaflex may cause additive hypotensive effects, potentially resulting in dizziness or fainting. Regular blood pressure monitoring and dosage adjustments may be necessary.

  • The additive hypotensive effects can lead to a sudden drop in blood pressure, causing dizziness.
  • Symptoms of low blood pressure may include lightheadedness and blurred vision.
  • Excessive hypotension may result in a slower heart rate.

Birth Control Pills

Like Tizanidine and alcohol, hormonal birth control can affect Tizanidine mechanism of action.

Oral contraceptives have the potential to modulate the blood concentrations of Tizanidine, impacting its clearance from the body. In women using combined hormonal oral contraceptives, the clearance of Tizanidine is substantially reduced by approximately 50%.

This reduced clearance of Tizanidine results in elevated blood concentrations of the drug. The implications of this interaction are significant, particularly concerning the hypotensive effects of Tizanidine.

  • Exacerbation of common side effects associated with Tizanidine.
  • Potential reduction in the effectiveness of oral contraceptives.

Caffeine-containing Products (Coffee, Energy Drinks)

Caffeine does not inherently exhibit such a profound interaction.

Yet, excessive caffeine consumption may have a modulating effect on the Tizanidine mild side effects. Patients using Tizanidine should have moderate caffeine intake.

  • Difficulty falling or staying asleep with disrupted sleep patterns.
  • Patients sensitive to changes in heart rate may experience palpitations.

Light Tizanidine Drug Interactions

Light Tizanidine drug interactions suggest minimal or subtle effects when Tizanidine is combined with certain medications. Here are the top light Tizandine drug interactions:

Nonsteroidal Anti-Inflammatory Drugs, NSAIDs (Ibuprofen, Naproxen)

  • Ibuprofen or Naproxen can amplify the sedative effects of Tizanidine.
  • This interaction is generally considered mild but requires caution, especially in individuals more susceptible to increased Central Nervous System (CNS) depression.

Antiarrhythmics (Amiodarone, Dronedarone)

  • Tizanidine may interact with certain antiarrhythmic drugs, potentially causing additive effects on heart rate.
  • Particularly important for individuals with pre-existing heart conditions, due to the critical role of cardiac function.

Antidepressants (Fluoxetine, Sertraline):

  • Certain antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), may interact with Tizanidine, leading to increased sedation.
  • Patients should be monitored for heightened CNS depression, especially during initial co-administration.

Antipsychotics (Risperidone, Olanzapine):

  • Antipsychotic medications may result in additive sedative effects similar.
  • Important for individuals with a history of sensitivity to CNS depressants.

Anti-seizure Medications (Gabapentin, Pregabalin):

  • Some anti-seizure medications may interact with Tizanidine, causing increased sedation.
  • Caution in individuals with epilepsy or other seizure disorders.

Benzodiazepines (Alprazolam, Diazepam):

  • Combining Tizanidine with benzodiazepines may lead to additive sedative effects.
  • Caution and close monitoring are essential, especially in individuals with a history of benzodiazepine addiction or sensitivity.

Get Professional Help in the Case of Tizanidine Addiction

A case study from the NIH reports that addiction to this drug occurs when the average dose exceeds 20 to 36mg. Addiction may develop as a result of misuse or prolonged use of this medication.

For Tizanidine and alcohol interactions or treat types of addiction, seek professional help. Abruptly stopping the medication is risky, causing severe symptoms. Choose outpatient or inpatient treatment based on severity—access medical assistance; detox in reputable rehab centers.

People Also Ask

Can I drink alcohol while taking Tizanidine?

It is strongly advised to avoid alcohol while taking Tizanidine. The combination may intensify sedative effects, increasing the risk of drowsiness, dizziness, and impaired coordination. Therefore, combining tizanidine and beer is never a good idea.

Can you drink coffee after taking Tizanidine?

Moderate coffee consumption after taking Tizanidine is generally acceptable. Excessive caffeine intake may amplify mild side effects like nervousness or insomnia associated with Tizanidine. Proceed with caution.

Can you take tizanidine with tramadol?

The combination of Tramadol and Tizanidine is associated with an increased risk of sedation, respiratory depression, and other CNS effects that may occur when these drugs are used concurrently. In some rare cases, these medications could be prescribed together. However, it is essential to be supervised by a professional healthcare provider. Make sure to always follow your physician’s recommendations before combining these medications.

Can you take tizanidine with gabapentin?

Tizanidine and gabapentin taken together may increase the risk of experiencing significant side effects such as drowsiness, sedation, dizziness, confusion, and impaired concentration. The elderly are especially vulnerable and may experience impaired cognition, judgment, and motor coordination. Although it is possible that these medications can be taken together, it is crucial to consult your healthcare provider for personalized advice.

What should someone taking Tizanidine avoid?

Tizanidine interactions can lead to harmful complications; thus, it is important to be aware of what to avoid while taking Tizanidine. When prescribed with Tizanidine, you should avoid concomitant consumption of alcohol, CNS depressants, and opioids. Use caution with birth control pills, as Tizanidine may interact. Be mindful of antihypertensive medications, as combining them may lead to excessive blood pressure reduction.

Page Sources

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  2. Ghanavatian, S. (2023, August 28). Tizanidine. StatPearls - NCBI Bookshelf. - Retrieved on february 2, 2024
  3. Semenchuk, M. R., & Sherman, S. (2000). Effectiveness of Tizanidine in Neuropathic Pain: An Open-Label Study. The Journal of Pain, 1(4), 285-292. - Retrieved on february 2, 2024
  4. Pinheiro, E. A., & Stika, C. S. (2020). Drugs in pregnancy: Pharmacologic and physiologic changes that affect clinical care. Seminars in Perinatology, 44(3), 151221. - Retrieved on february 2, 2024
  5. Granfors, M. T., Backman, J. T., Neuvonen, M., & Neuvonen, P. J. (2004). Ciprofloxacin greatly increases concentrations and hypotensive effect of tizanidine by inhibiting its cytochrome P450 1A2–mediated presystemic metabolism. Clinical Pharmacology & Therapeutics, 76(6), 598-606. - Retrieved on february 2, 2024
  6. Tizanidine Hydrochloride Tablets 2 mg and 4 mg. (n.d.). - Retrieved on february 2, 2024

Published on: February 19th, 2020

Updated on: May 17th, 2024

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