Top cyclobenzaprine (Fexmid ) alternatives and how to switch your Rx

Compare cyclobenzaprine alternatives | Methocarbamol | Zanaflex | Metaxalone | Baclofen | Naprosyn | Natural alternatives | How to switch meds

Did you wake up with a stiff neck or neck pain? Is your low back spasming for some reason and causing acute low back pain? The muscle spasm pain can be searing and intense; it may have you guardedly moving for fear of triggering a jolt. Cyclobenzaprine, an FDA-approved prescription medication, has long been a go-to muscle relaxant for short-term use for muscle spasms and pain relief. Known also by its brand name Fexmid and former brand-name Flexeril, cyclobenzaprine plays a frequent role in acute musculoskeletal pain control via either of these regular-release forms or via its extended-release form, Amrix. Cyclobenzaprine shares structural similarities with tricyclic antidepressants, including amitriptyline and nortriptyline. However, all forms of the drug have flaws, and you may be interested in an alternative to avoid one of its common side effects. Despite its notoriety, it is not necessarily effective for everyone. There are many alternatives to get better relief from muscle pain.

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What can I take in place of cyclobenzaprine?

Skeletal muscle relaxants are a unique and interesting drug class. There are no conclusive comparison studies to determine which muscle relaxant is more effective. Costs vary, but a SingleCare discount card can help if this is a concern when comparing options. Each member of this drug family has its idiosyncrasies when it comes to side effects. This means you may be able to choose a different muscle relaxant even if Fexmid fails you. If not, you could step outside the med class and look at nonsteroidal anti-inflammatory medications (NSAIDs), benzodiazepines, or analgesics, such as acetaminophen. You will need more information to take to your healthcare provider for medical advice.

Top 5 cyclobenzaprine alternatives

The following are some of the most common alternatives to cyclobenzaprine.

1. Methocarbamol

Brand-name oral Robaxin is not available anymore in the United States, but its generic version, methocarbamol, is still available and in use. Like cyclobenzaprine, methocarbamol is considered an antispasmodic skeletal muscle relaxant. They exert their effect by acting on the central nervous system (CNS), namely the brain. Both methocarbamol and cyclobenzaprine have serious adverse effects to be wary of. They can cause drowsiness, unsteadiness, and blurred vision, which all contribute to a heightened risk of falls and other injuries. Due to those adverse effects, they are included in the Beers list of medications to generally be avoided in most older adults over 65 years. However, methocarbamol does avoid the anticholinergic effects that cyclobenzaprine can produce, such as dry mouth, constipation, and a prolonged QT interval on ECG assessment of heart rhythm.

2. Zanaflex

Zanaflex and its generic formulation, tizanidine, can also lead to prolongation of the QT interval, so it will not help if avoiding this potential side effect is important. However, Zanaflex is classified as an antispasticity muscle relaxant, making it a potential choice for those needing relief from muscle spasticity. Besides its adverse effects that include sedation, dizziness, and dry mouth, the drug also carries the risk of a withdrawal syndrome when it is stopped. The withdrawal symptoms can include elevated blood pressure, fast heart rate, and hypertonia (elevated muscle tone). 

3. Metaxalone

Metaxalone was formerly known by its brand-name Skelaxin. It has some similarities to methocarbamol and cyclobenzaprine, in that it is an antispasmodic that likely helps with skeletal muscle pain by being a CNS depressant that slows brain function. Like Zanaflex, you have to be careful about a host of potential drug interactions and side effects with metaxalone. Be sure to review your list of prescription medications, over-the-counter drugs, and supplements with a healthcare provider before deciding to start metaxalone or any of the muscle relaxants.

4. Baclofen

Known by its brand-name Lioresal, the antispasticity drug baclofen acts on the CNS in a manner similar to gamma amino-butyric acid (GABA). Its use tends to be more for spasticity in the setting of CNS lesions such as multiple sclerosis (MS), cerebral palsy, and spinal cord injuries. Although CNS depression can occur, it may be less than with other muscle relaxants. Like all medications, side effects can occur with the use of Baclofen. However, a withdrawal syndrome, including hallucinations and seizures, can occur with abrupt discontinuation of baclofen. You should have the medical advice of the prescribing healthcare professional before starting or stopping one of these drugs.

5. Naprosyn

You might be surprised to see Naprosyn on this list, being that it is a non-steroidal anti-inflammatory drug (NSAID) commonly used for musculoskeletal conditions and not a muscle relaxant. The reason is that NSAIDs have more evidence to back their effectiveness, particularly for back pain, no pun intended. In fact, one emergency room study found that adding metaxalone, Zanaflex, or baclofen to the NSAID ibuprofen did not provide better relief of acute lower back pain than the NSAID alone at one week after the presentation. NSAIDs have their own list of adverse effects for sure, but they do avoid the side effects of drowsiness and instability that can arise from cyclobenzaprine and its fellow muscle relaxants. 

Neither cyclobenzaprine nor NSAIDs are on the Drug Enforcement Agency’s (DEA) controlled substance list. Soma, opiates, tramadol, and Valium are some of the controlled substances with significant abuse potential that are used for musculoskeletal pain. Just because cyclobenzaprine is not risky enough to be on the DEA list does not mean that it has no abuse potential.

Natural alternatives to cyclobenzaprine

The cautionary notes on cyclobenzaprine have probably left you wanting to turn over every stone in looking into alternatives. Natural remedies are popular, particularly for nocturnal leg cramps, a type of muscle spasm we have all likely experienced. Everyone seems to have their opinion on what works, but studies have not proven many to be effective. B-complex vitamins and vitamin E might be helpful. If you are deficient in magnesium, then a magnesium supplement may help with leg cramps, but otherwise, it will likely be ineffective, according to a published review. There seems to be no perfect pill for muscle spasms. Non-pharmacological options like stretching and physical therapy may be something to consider for muscle pains.

How to switch to a cyclobenzaprine alternative

Whether you are interested in an alternative because cyclobenzaprine has been ineffective or has been causing adverse effects, you now know what else is out there. Taking that information with you, you should have an appointment with your medical provider to discuss it. You certainly do not want to make any changes on your own. As a team, you both can settle on a decision after considering all the options.