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Tizanidine (Tizanidine Hydrochloride) - Indications and Dosage

 
 



INDICATIONS AND USAGE

Tizanidine tablet is a central alpha-2-adrenergic agonist indicated for the management of spasticity. Because of the short duration of therapeutic effect, treatment with tizanidine tablets should be reserved for those daily activities and times when relief of spasticity is most important [see Dosage and Administration].

DOSAGE AND ADMINISTRATION

Dosing Information

Tizanidine tablets may be prescribed with or without food. Once the formulation has been selected and the decision to take with or without food has been made, this regimen should not be altered.

Food has complex effects on tizanidine pharmacokinetics, which differ with the different formulations. Tizanidine capsules and tizanidine tablets are bioequivalent to each other under fasting conditions (more than 3 hours after a meal), but not under fed conditions (within 30 minutes of a meal). These pharmacokinetic differences may result in clinically significant differences when switching administration of tablet and capsules and when switching administration between the fed or fasted state. These changes may result in increased adverse events, or delayed or more rapid onset of activity, depending upon the nature of the switch. For this reason, the prescriber should be thoroughly familiar with the changes in kinetics associated with these different conditions [see Clinical Pharmacology].

The recommended starting dose is 2 mg. Because the effect of tizanidine tablets peaks at approximately 1 to 2 hours post-dose and dissipates between 3 to 6 hours post-dose, treatment can be repeated at 6 to 8 hour intervals, as needed, to a maximum of three doses in 24 hours.

Dosage can be gradually increased by 2 mg to 4 mg at each dose, with 1 to 4 days between dosage increases, until a satisfactory reduction of muscle tone is achieved. The total daily dose should not exceed 36 mg. Single doses greater than 16 mg have not been studied.

Dosing in Patients with Renal Impairment

Tizanidine tablets should be used with caution in patients with renal insufficiency (creatinine clearance < 25 mL/min), as clearance is reduced by more than 50%. In these patients, during titration, the individual doses should be reduced. If higher doses are required, individual doses rather than dosing frequency should be increased [see Warnings and Precautions].

Dosing in Patients with Hepatic Impairment

Tizanidine tablets should be used with caution in patients with any hepatic impairment. In these patients, during titration, the individual doses should be reduced. If higher doses are required, individual doses rather than dosing frequency should be increased. Monitoring of aminotransferase levels is recommended for baseline and one month after maximum dose is achieved, or if hepatic injury is suspected [see Use in Specific Populations].

Drug Discontinuation

If therapy needs to be discontinued, particularly in patients who have been receiving high doses (20 mg to 36 mg daily) for long periods (9 weeks or more) or who may be on concomitant treatment with narcotics, the dose should be decreased slowly (2 mg to 4 mg per day) to minimize the risk of withdrawal and rebound hypertension, tachycardia, and hypertonia [see Drug Abuse and Dependence].

DOSAGE FORMS AND STRENGTHS

Tablets

Tizanidine Tablets USP, 2 mg are white to off white, oval, flat, beveled edged tablets embossed with “R179” on one side and “bisecting score” on other side.

Tizanidine Tablets USP, 4 mg are white to off white, oval, flat, beveled edged tablets embossed with “R180” on one side and “quadrisecting score” on other side.

HOW SUPPLIED/STORAGE AND HANDLING

Tizanidine Tablets

Tizanidine Tablets USP, 2 mg are white to off white, oval, flat, beveled edged tablets embossed with “R179” on one side and “bisecting score” on other side.
Unit dose packages of 30 (3 x 10) NDC 68084-775-21

Tizanidine Tablets USP, 4 mg are white to off white, oval, flat, beveled edged tablets embossed with “R180” on one side and “quadrisecting score” on other side.
Unit dose packages of 100 (10 x 10) NDC 68084-645-01

Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F) [See USP Controlled Room Temperature.]

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