Tizanidine vs. Flexeril and Other Zanaflex Alternatives

Last Updated: October 11, 2021

Authored by Roger Weiss, MD

Reviewed by Michael Espelin APRN

Tizanidine (Zanaflex) and Flexeril (Cyclobenzaprine) are both muscle relaxants. They are used by medical personnel to treat muscle tightness arising from painful musculoskeletal conditions and injuries.

Although these medications are similar in numerous ways, they have some unique differences in their mechanism of action, side effects, and uses. This article outlines the similarities and differences between Tizanidine vs. Flexeril and discusses possible alternatives among muscle relaxants and other drug classes.

What Tizanidine and Flexeril Are?

Zanaflex is a centrally acting alpha 2 adrenergic agonist that was first approved and administered in the US in 1996. It is a short-acting muscle relaxant primarily administered to patients experiencing muscle cramps and stiffness due to chronic disorders like multiple sclerosis and spinal cord lesions.

Flexeril, a generic name for Cyclobenzaprine, is an effective alternative to Tizanidine. It is commonly used to treat severe pain caused by acute musculoskeletal conditions because its long-term efficacy is unclear. Based on studies by IQVIA, a total of 28.4 million cyclobenzaprine prescriptions were dispensed in the US in 2017.

Healthcare professional in the pharmacy

Tizanidine vs. Flexeril: What are the Similarities?

Comparing the similarities between Zanaflex vs. Cyclobenzaprine, both are used as muscle relaxants to relieve discomfort caused by acute and chronic musculoskeletal diseases. They are effective treatments for fibromyalgia, multiple sclerosis, sciatica, tetanus-associated tremors, and muscle strains and stiffness. Both are also used to treat sleep disorders and share some common side effects.

Side Effects of Zanaflex and Cyclobenzaprine

Both Zanaflex and Cyclobenzaprine share some common side effects.

These Include:

  • Constipation
  • Dizziness
  • Dry mouth
  • Blurred vision
  • Muscle weakness

What Are the Differences Between Tizanidine vs. Flexeril?

The differences between Zanaflex and Cyclobenzaprine are as vast as the similarities. Although they are both significant in treating sustained muscle contractions and discomfort, they have unique differences that must be understood.

Cyclobenzaprine adverse effects that differ from that of Zanaflex include:

  • Low blood pressure
  • Confusion
  • Nausea
  • Headache
  • Seizures
  • Abdominal discomfort

Cyclobenzaprine counts as a preferred and safer alternative to Zanaflex due to its fewer side effects and interactions with other drugs.

A few of these differences have been outlined in the table below:

Tizanidine Cyclobenzaprine (Flexeril)
Brand Names Zanaflex Amrix

Fexmid

Flexeril – No longer used in the U.S.

Drug Class and Type Alpha 2 Adrenergic Agonist Skeletal Muscle Relaxant
Treatment Length  Treatment duration is disease-specific. However, it can be used for the short or long term duration Short-term use – 2 to 3 weeks (regardless of the disease).
Approved Age of Use  18 years and older 15 years and older
Prescription Forms

Approved Dosage 

Oral Tablet, Oral Capsule

Initial dose -2mg

Subsequently – 2mg 6 to 8 hourly

Note: The dose may be increased by 2 to 4 mg every one to four days. Each individual can take a maximum of 36 mg daily.

Oral tablets, Oral Capsules, extended-release

Immediate-release tablets or capsules -5 to 10 mg thrice daily

Extended-release formulas – 15 to 30 mg daily (once)

Note: For immediate-release tablets, the dose can be increased to 7.5-10mg, depending on the patient’s age.

Half-Life Zanaflex half-life is approximately 2.5 hours Flexeril half-life is 18 hours

What Are the Drugs Alternative to Tizanidine?

Some effective alternatives include Flexeril, Soma (Carisoprodol), Baclofen, Robaxin (methocarbamol), and Valium. Here are detailed comparisons of a few.

Tizanidine vs. Soma

What do Zanaflex and Soma have in common? Both medications are similar in various ways.

They both become helpful when conventional pain relievers fail to ease muscle pain. When taken together with alcohol or alcoholic beverages, they may interact to cause severe CNS depression. They also share some common side effects, such as drowsiness, dizziness, and stomach agitation.

In contrast, Tizanidine vs. soma are recommended for different durations. Soma can only be used for a maximum of three weeks and Zanaflex is safer for prolonged durations.

While they both proffer the same effect, online reviews show Soma to be more effective than Zanaflex pills. However, Zanaflex is the cheaper option.

Baclofen Vs Tizanidine

Comparison between Baclofen vs. Tizanidine depicts the similarities between them. They are both administered to treat sustained muscle contractions due to debilitating musculoskeletal conditions like multiple sclerosis. However, unlike Zanaflex, Baclofen is a first-choice treatment for spasms.

Based on research published in the Canadian Journal of Neurosciences, both medications have similar efficacy. Therefore, both drugs are no different. However, the after-effects are slightly different and can influence drug choice.

Methocarbamol vs Tizanidine

Methocarbamol vs. Tizanidine are potent centrally acting muscle relaxants that share many similarities.

Like Tizanidine, Methocarbamol, a generic name for Robaxin, has sedative effects and can be used to treat sleep difficulties. However, it is generally less sedative compared to Tizanidine. Methocarbamol and Tizanidine share specific side effects like constipation and dizziness.

Robaxin is most effective in the treatment of severe acute postoperative pain due to major orthopedic surgeries. It is also prescribed alongside rest and physical therapy for spasms due to tetanus, strokes, and other musculoskeletal conditions.

In contrast to Zanaflex, Methocarbamol can be administered orally and parentally and is one of the cheapest muscle relaxants available.

Zanaflex vs. Xanax

Alprazolam, marketed under the brand name Xanax, belongs to the benzodiazepines drug class. Although it is an FDA-approved anxiolytic, it helps relieve muscle tension and spasms from anxiety or panic attacks. However, Xanax is primarily used to treat seizures, anxiety disorder, and premenstrual syndrome.

In comparison, Zanaflex vs. Xanax are both fast-acting and act by diminishing the sensitivity of specific receptors in the brain. They are both available in immediate and extended-release tablets.

In contrast, Alprazolam causes severe after-effects such as memory loss, decreased libido, and speech disturbances and is also habit-forming. As a result of these factors, it is rarely prescribed. Xanax also reacts with grapefruits, grapefruit juice, and alcohol to cause severe side effects.

Unlike Tizanidine, Alprazolam is a controlled drug under the schedule IV controlled substances in the controlled substance act.

Valium vs. Tizanidine

Another potent and occasionally used muscle-relaxing drug is Valium. Diazepam, marketed as Valium, is a benzodiazepine that is available in oral suspension tablets and injections.

Tizanidine vs Valium are antispastic and antispasmodic agents. Diazepam relieves muscle pain and rigidity arising from inflammation and trauma. It also acts as an anticonvulsant and anti-anxiety medication. Because of its sedative properties, Valium can be used to treat sleep disorders.

Both drugs are short-acting and, as a result, are most useful for immediate use during important physical activities. However, Valium is only recommended for short-term use because it is habit-forming. It also has many drug interactions and, as such, must be used with great care and only taken with medical recommendations.

What Are Tizanidine Over-the-Counter and Natural Alternatives?

Muscle tightness, tension, and pain usually arise due to muscle spasms and spasticity. Although various factors can cause it, muscle spasm is a common symptom of most musculoskeletal conditions.

In cases of mild spasms and pain, rest, physical therapy, over-the-counter (OTC) drugs, and natural muscle relaxants can be taken.

OTC drugs are usually the first-line treatment for muscle discomfort and tension against more potent drugs like tizanidine. They are most effective for mild neck and lower back pain.

Some Common OTC Muscle Relaxants Used Include:

  • Ibuprofen (Advil, Motrin IB)
  • Naproxen
  • Aspirin
  • Acetaminophen (Tylenol)
Pharmacist is holding capsule pack

Non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen and Naproxen are usually taken with or without acetaminophen.

Natural alternatives can also help treat milder muscle pain and tension.

Here Are Some Natural Alternatives:

  • Chamomile
  • Cayenne pepper
  • Magnesium
  • Vitamin D
  • Blueberry smoothies
  • Cherry juice
  • Curcumin
  • Cannabidiol oil
  • Lemongrass
  • Peppermint oil
  • Arnica gel
  • Massage and physical therapy

Although this is not exhaustive of the list of options, these serve as excellent muscle relaxants in the face of mild muscle tension and spasms.

The bottle of peppermint oil

What Is the Best Alternative to Tizanidine?

Depending on the reason for choosing a different medication, any choice can be a good alternative. It is always essential to seek professional advice when getting treatment. A doctor can help the individual to select the best substitute for Zanaflex and choose between Flexeril, Baclofen, and Soma.

When switching drugs, it is vital to choose one of the reputable rehabilitation centers in the US to get expert assistance to ensure proper management of dependence or withdrawal symptoms.

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Page Sources

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  3. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012. https://www.ncbi.nlm.nih.gov/books/NBK548375/
  4. Corey Witenko, Robin Moorman-Li, Carol Motycka, Kevin Duane, Juan Hincapie-Castillo, Paul Leonard, Christopher Valaer. Considerations for the Appropriate Use of Skeletal Muscle Relaxants for the Management Of Acute Low Back Pain. P T. 2014 Jun; 39(6): 427-435. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103716/
  5. Bass B, Weinshenker B, Rice GP, Noseworthy JH, Cameron MG, Hader W, Bouchard S, Ebers GC. Tizanidine versus baclofen in the treatment of spasticity in patients with multiple sclerosis. Can J Neurol Sci. 1988 Feb;15(1):15-9. https://www.ncbi.nlm.nih.gov/pubmed/3345456
  6. Lataste X, Emre M, Davis C, Groves L, Comparative profile of tizanidine in the management of spasticity. Neurology. 1994. https://pubmed.ncbi.nlm.nih.gov/7970011/

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.