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Tizanidine Interactions: Taking Zanaflex and Alcohol or Drugs

Last Updated: October 11, 2021

Authored by Roger Weiss, MD

Reviewed by Michael Espelin APRN

Taking Zanaflex with other substances may lead to different reactions that may adversely affect a person’s health. This article will discuss the result of mixing Zanaflex with other medications and the importance of medical supervision.

Tizanidine and Alcohol Interaction

Taking Tizanidine while drinking alcohol can increase the risk of severe side effects. The side effects of Tizanidine interactions, especially with alcohol, are most likely to occur at the initial stage of treatment, following an increase in dosage, or when treatment is restarted after a previous interruption.

Dangers of Combining Tizanidine and Alcohol

Combining Tizanidine and alcohol can be dangerous to one’s health.

Individuals who combine these substances may experience some side effects, which include:

  • Extreme drowsiness or sedation
  • Confusion
  • Difficulty concentrating
  • Impairment in judgment
  • Thinking and motor coordination

Keep in mind that combining Tizanidine and alcohol may also result in the reduction of blood pressure.

Some of the Apparent Symptoms a Person May Feel Include:

  • Headaches
  • Fainting
  • Dizziness
  • Changes in heart and pulse rate
Drugs and alcohol interaction

Some of these side effects are most common at the beginning of treatment. The dangers of Tizanidine interactions with alcohol may adversely depress the human body. Their combination can lead to shallow or even slowed breathing. This may seldom lead to brain damage of the individual.

An overdose may occur from combining Tizanidine and alcohol. This can be so severe that it eventually becomes fatal to the health of the individual taking it. If the user notices any overdose symptoms from a friend or a loved one, try consulting a doctor.

Drugs That Should Not Be Used With Zanaflex

Some drugs should not be used with Zanaflex. These medications contain some drug components that may slow down the breakdown and eventually lead to increased drowsiness, slowed reflexes, and sedation. As a result of the MOA of this drug, a central acting alpha2 adrenergic agonist can cause significant hypotension in patients. Here is some information on some drugs that should not be combined.

Zanaflex and Tramadol Interaction

Although both medications belong to different drug classes, they share similar side effects.

A combination of Zanaflex and Tramadol can increase a person’s risk of:

  • Nervousness
  • Drowsiness
  • Stomach pain
  • Dizziness
  • Constipation
  • Vomiting
  • Fever
  • Skin rash

Tizanidine and Ambien

Combining Tizanidine and Ambien may increase some side effects in the system.

Some of These Effects Include:

  • Drowsiness
  • Dizziness
  • Confusion
  • Difficulty concentrating

For the elderly ones, a combination of Tizanidine and Ambien may experience impairment in judgment and thinking.

Tizanidine and Ibuprofen Interaction

Tizanidine and Ibuprofen are a combination of two medicines that help relieve pain and aid muscle relaxation. Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that works by blocking the release of chemical messengers that may cause pain and inflammation, such as redness and swelling while the other is a muscle relaxant. Its mechanism is primarily on the center of the spinal cord and brain to relieve muscle spasm or stiffness and relieve pain and increase movement around the muscles.

A person who mixes Tizanidine and Ibuprofen may experience some side effects, which include:

  • Nausea
  • Stomach pain
  • Heartburn
  • Indigestion
  • Dizziness
  • Weakness
  • Dryness in the mouth and sleepiness
Man is suffering from the stomach pain

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

Tizanidine and Cipro

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

Tizanidine interactions with ciprofloxacin can be dangerous, especially in elderly patients. Ciprofloxacin greatly enhanced the results of this medication. The decrease in systolic (upper) blood pressure to a 90-mmHg level or even less was alarming. Typical hypotension can be dangerous. An example is that of elderly ones and also patients who may be suffering from heart problems. In addition, the central nervous system effects of Zanaflex were significantly enhanced by Cipro.

The drug interaction results from inhibition of the liver mechanism of Tizanidine and Cipro. Further studies are still being conducted to examine whether there are other interactions between these drugs.

Tizanidine and Fluvoxamine

Another severe Tizanidine interaction involves the use of fluvoxamine. A combination of both substances may affect an individual as the person will suffer from Tizanidine toxicity. These include; sedation, bradycardia, and hypotension.

Fluvoxamine can improve the drug’s minimum concentration and half-life by as much as 12-fold and 3-fold.

Thiabendazole: Avoid Tizanidine Interactions

The usage of thiabendazole, which is a potent CYP1A2 hepatic enzyme inhibitor, can improve the concentration of this drug. Besides the usual hypotension and drowsiness, an individual is at risk of psychomotor impairment.

Other alpha-2 agonist drugs that often cause a sharp decrease in blood pressure when used with this substance include:

  • Clonidine
  • Methyldopa
  • Guanfacine
  • Guanabenz

If an individual notices frequent recurrence in the effects stated above, the person should speak to a doctor.

Serious Interactions with Zanaflex That Require Medical Supervision

Zanaflex is a prescription drug that treats symptoms of muscle stiffness associated with conditions like cerebral palsy and other neurological disorders. One may experience some severe interactions when taking this medicine. In such cases, it is recommended to meet a medical expert.

Zanaflex and Opioids

Concomitant use of both substances may lead to some health conditions.

They Include:

  • Respiratory depression
  • Hypotension
  • Profound sedation
  • Death
  • Unusual dizziness
  • Lightheadedness
  • Extreme sleepiness
  • Unresponsiveness

The same interactions are observed with codeine, alfentanil, and opium. With the approval of a physician, these combinations are only given to patients for whom alternative treatment options are inadequate.

If concurrent use is essential, the first dose of this drug should be decreased to the lowest effective dose, and treatment duration should be shortened.

Tizanidine and Gabapentin

A combination of both Tizanidine and Gabapentin can cause additive CNS depression. Patients should be observed for symptoms of sedation. Gabapentin use should be initiated at the least approved dose. Proper education about the symptoms and risk of excessive CNS depression and monitoring is vital. A mild slowing of the CNS may make an individual feel more relaxed and less anxious.

Some symptoms that may be exhibited when mixing Tizanidine and Gabapentin include:

  • Drowsiness
  • Lack of coordination
  • Slowed or slurred speech

If the CNS becomes worse, the symptoms of mixing both substances, an individual may experience the following:

  • Slowed breathing
  • Poor judgment
  • Slowed heart rate
  • Confusion
  • Lethargy

Once one feels some of the above symptoms while taking the medication, the user should speak to a doctor.

Amiodarone and Cimetidine

Cimetidine is another potent CYP1A2 inhibitor that can cause an extraordinary increase in Concentration. The same side effect is observed with amiodarone. There is an increased risk of hypotension, bradycardia, and excessive drowsiness

Oral Contraceptives

Oral contraceptives can also improve the blood concentrations in the system. The clearance of this drug is 50% lower in women who take combined hormonal oral contraceptives with this drug. Increased hypotensive effects may occur.


Tizanidine is a sensitive CYP1A2 substrate. Givosiran may also reduce hepatic CYP1A2 enzyme activity, which, in turn, can improve tizanidine hydrochloride side effects. If use is necessary, reducing the drug dose must be considered.

Drugs That Can Cause Some Risks When Taken with Zanaflex

Some drugs have potential risks when combined with Zanaflex. The following drugs should be avoided when using Zanaflex.

Clonazepam and Xanax

Using both substances concurrently may lead to additive CNS depression. This is also true when taken with Xanax. A mixture of Clonazepam can lead to cognitive deficits. People who abuse these drugs may experience problems relating to Concentration or difficulty focusing. Some may also have difficulty speaking. Memory impairment may develop for some individuals.

A combination of these drugs can lead to brain damage. Depression may occur, and people who constantly abuse these substances together are at a higher risk of psychotic experiences and eventually become aggressive.

The dangers of mixing Clonazepam and Xanax cannot be overemphasized. Recovery from this type of substance is possible with the assistance of a professional or a medical expert.

Acebutolol and Triamterene

Zanaflex interactions with antihypertensive agents can result in significant hypotension. Patients who combine Zanaflex with other anti-hypertensive drugs are expected to lie down when they notice symptoms such as lightheadedness or dizziness. If possible, they should not make any movement; instead, they remain to lie down till the symptoms are over.


Aliskiren may intensify the effects of this substance on blood pressure if given concomitantly. This additive effect may be desirable, but individual doses must be adjusted accordingly. Electrolytes and blood pressure should be routinely monitored for individuals receiving Aliskiren.


A dose adjustment of this substance may be needed when administered with cannabidiol. Additive drowsiness and sedation may occur. Avoid using machinery, driving, or doing anything that requires mental alertness when using this medication. A person who combines Zanaflex and cannabidiol should consult a doctor. This will help the individual manage the side effects.


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

Individuals Who Combine These Drugs May Experience:

  • Multiple sclerosis (nervous system disease that affects the spinal cord and brain damage)
  • Nausea (having an urge to vomit)
  • Narcolepsy- sleep disorder
  • Migraine
  • Anxiety and stress
  • Insomnia


Use caution when administering Teriflunomide and Zanaflex concurrently. Teriflunomide, a weak inducer of CYP1A2, can decrease drug exposure and cause a reduction in efficacy.

Get Professional Help in 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. An individual taking Zanaflex pills or capsules for an extended period will experience symptoms once the individual decides to stop.

In some cases, addiction may develop as a result of misuse or prolonged use of this medication. Tizanidine interactions with other drugs most times affect the central nervous system, which often leads to withdrawal symptoms when it is stopped.

The withdrawal of this drug can be managed by restarting and gradually reducing the dosage until the cessation of the drug.

An individual taking this drug in high doses for a period of up to nine weeks should seek professional help if such symptoms are notable:

  • Tachycardia
  • Increased spasticity
  • Rebound hypertension

The side effects of this medication may arise after the medication is stopped. This is why doctors regulate the process. Some of the warnings are related to the withdrawal of the drug.

These Warnings Include:

  • Liver injury
  • Hypotension
  • Increased drowsiness
  • Hallucination
  • Withdrawal adverse reactions

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.

Going off the medication on a personal level is dangerous. This can lead to more severe symptoms. Zanaflex interactions with other drugs can increase danger and complicate matters. Treatment can be completed in an outpatient capacity. Depending on the severity of the patient, inpatient treatment is a better option. Medical help is available for everyone who is addicted to this medication. Detox is best done in a reputable addiction rehab center.

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Page Sources

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Published on: February 19th, 2020

Updated on: October 11th, 2021

About Author

Roger Weiss, MD

Dr. Roger Weiss is a practicing mental health specialist at the hospital. Dr. Weiss combines his clinical practice and medical writing career since 2009. Apart from these activities, Dr. Weiss also delivers lectures for youth, former addicts, and everyone interested in topics such as substance abuse and treatment.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.

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