Medicine that relaxes you


Anti-Anxiety Medications (Benzodiazepines) | CAMH

Overview

Anti-anxiety medications help reduce the symptoms of anxiety, such as panic attacks or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines.

Benzodiazepines are a group of medications that can help reduce anxiety and make it easier to sleep. They are also used as a muscle relaxant, to induce sedation for surgery and other medical procedures, and in the treatment of seizures and alcohol withdrawal. Benzodiazepines are also called minor tranquillizers, sedatives or hypnotics. They are the most widely prescribed psychoactive drugs in the world.

The calming effects of benzodiazepines can often be achieved without drugs.

Various kinds of exercise, such as walking, running, yoga or tai chi can help, as can reducing the stress in your life and taking time for relaxing activities such as meditation, reading a book or having a warm bath. Talking with a trusted friend, family member or therapist and working out the problems that are troubling you can also help. Whenever possible, these approaches should be tried first, before benzodiazepines. However, when non-drug approaches are not possible or do not help, benzodiazepines can provide relief.

When used appropriately, benzodiazepines are safe and effective drugs. They do, however, have potential for abuse and can be addictive. For this reason, they are usually only recommended for short-term or occasional use.

Do I need this treatment?

A certain amount of anxiety or insomnia is a normal reaction to what is happening in your life. You may worry or feel stressed, and sometimes these feelings can keep you up at night. Most often, these feelings pass and are not a problem. However, these feelings can become a problem when they continue over a longer term, cause severe distress, make you feel physically ill and affect your behaviour. This kind of anxiety may be triggered by a challenging life event. It can also be a symptom of a mental health problem.

The ability to fall asleep and to sleep through the night can be affected by many types of health problems. These include physical conditions that cause pain or trouble breathing, as well as mental health problems. When sleep is disrupted, health can be further affected.

While each situation is unique and different treatment approaches may be called for, benzodiazepines can help to provide relief.

What does Anti-anxiety Medications (Benzodiazepines) do?

Benzodiazepines enhance the activity of the neurotransmitter GABA—a chemical in the brain that helps you to feel calm. Their effect also produces drowsiness, making it easier to fall asleep and sleep through the night.

Side effects of Anti-anxiety Medications (Benzodiazepines)

The side-effects of benzodiazepines are generally mild and may not be noticed when these drugs are used at low doses.

Common side-effects include:

  • drowsiness
  • sedation
  • dizziness
  • loss of balance.

At higher doses, side-effects can include:

  • confusion
  • disorientation
  • amnesia
  • breathing difficulties
  • depression.

Other possible effects, which are extremely rare, include agitation, hallucinations and nightmares. Reducing the dose can help to reduce side-effects.

Benzodiazepines can make it harder to learn and remember new information and to do certain physical and mental tasks. These abilities return to normal once the effect of the drug wears off.

When used to help you get to sleep, benzodiazepines can have some “hangover” effects, such as morning and daytime drowsiness.

Types of Anti-anxiety Medications (Benzodiazepines)

Many types of benzodiazepines are available in Canada. All benzodiazepines work the same way; however, the intensity and duration of their effects vary.

Benzodiazepines most commonly used to treat anxiety disorders are clonazepam (Rivotril)*, alprazolam (Xanax) and lorazepam (Ativan). Also used are bromazepam (Lectopam), oxazepam (Serax), chlordiazepoxide (once marketed as Librium), clorazepate (Tranxene) and diazepam (Valium).

Benzodiazepines used for the treatment of insomnia include lorazepam (Ativan), nitrazepam (Mogadon), oxazepam (Serax), temazepam (Restoril), triazolam (Halcion) and flurazepam (Dalmane).

Another drug used for insomnia is zopiclone (Imovane). This drug is similar to benzodiazepines and has similar side-effects. Zopiclone may have less abuse potential than some benzodiazepines; however, people can still become addicted to this drug.

Benzodiazepines are available in the form of tablets or capsules, which are taken by mouth. Some are also available as a sublingual tablet, which is dissolved under the tongue, or as a solution for injection.

* Medications are referred to in two ways: by their generic name and by their brand or trade names. Brand names available in Canada appear here in brackets. For example, alprazolam (Xanax) and lorazepam (Ativan).

Frequently Asked Questions

How long should I take benzodiazepines?

For most people, benzodiazepines are helpful only as a temporary measure, to be used only in the following ways:

  • on occasion, to help you sleep or when anxiety can’t be managed with non-drug approaches
  • daily, for up to a few weeks, to help re-establish sleep patterns or to reduce anxiety while waiting for an antidepressant or other treatment to take effect.

Some people may continue to use benzodiazepines for longer, even months or years. Some do so because they continue to find these drugs helpful and have agreed with their prescribing physician that the benefits of continuing to use them outweigh the risks. There are also those who continue to use benzodiazepines over a longer term because the prescribing doctor has not re-examined their continued use. In this instance, ask another doctor to review your prescription.

Are benzodiazepines addictive?

When used on occasion or daily for a few weeks, benzodiazepines have a low risk of addiction. This risk increases, however, when benzodiazepines are taken regularly for more than a few weeks, especially when they are taken in higher than normal doses. People with a history of substance abuse should avoid or minimize use of benzodiazepines as they are at higher risk of becoming addicted.

Signs of addiction include strong cravings for the effects of the drug, taking more of the drug than intended and continuing to use the drug despite the problems it may cause. Addiction may develop with or without physical dependence.

Physical dependence: When benzodiazepines are taken regularly over a long period of time, the body adapts to the presence of the drug. This is known as physical dependence. Physical dependence, on its own, is not the same as addiction. Signs of physical dependence include tolerance and withdrawal.

Tolerance: People are said to have developed tolerance to a drug when the same dose, taken over time, no longer has the desired effect. With benzodiazepines, it is known that:

  • Tolerance to the sleep-inducing effects may develop within a few weeks of regular use; however, tolerance does not usually develop with occasional use.
  • Tolerance to the anxiety-relieving effects is less likely to develop.
  • Tolerance to the effects of one type of benzodiazepine leads to tolerance to other benzodiazepines, and to other drugs with similar effects, including alcohol.

Some people who develop tolerance may take higher and higher doses to feel the same intensity of effect as when they started taking the drug. These people may find it difficult to stop using benzodiazepines.

Withdrawal: Withdrawal symptoms of benzodiazepines may be similar to the reasons why the drugs were prescribed in the first place. The severity of withdrawal symptoms depends on the type of benzodiazepine used, the amount used and length of time it is used, and on whether the drug is stopped abruptly. Symptoms can include headache, insomnia, anxiety, tension, sweating, difficulty concentrating, tremor, sensory disturbances, fatigue, stomach upset and loss of appetite. Severe withdrawal symptoms from regular use of benzodiazepines in high doses may include agitation, paranoia, delirium and seizures. Withdrawal symptoms generally begin within a few days after treatment is stopped, and they may continue for two to four weeks or longer.

How do I safely use benzodiazepines?

Take only as directed by your doctor; do not increase your dose.

Once you have slept well for two or three nights in a row, try to get to sleep without taking the medication.

If you have been taking benzodiazepines regularly for a few weeks or more, check with your doctor before reducing or stopping your medication.

How do I cut down or stop taking benzodiazepines?

Most often, benzodiazepines are prescribed to help people get through stressful situations or to provide relief while waiting for other treatment to take effect. When used in this way, on occasion or daily for a few weeks, most people can stop taking them without difficulty or withdrawal effects.

Stopping use can, however, be hard for some people, even when the use is short term. Problems are most likely to occur when:

  • the issues that caused you to take these drugs in the first place have not yet been dealt with
  • no other medication or talk therapy has been started.

People who wish to stop using benzodiazepines after using them regularly over a longer term will need to cut back their use gradually over an extended period of time. This approach reduces withdrawal effects and helps ensure success in stopping. Because the ideal process for cutting down varies depending on the benzodiazepine you are taking, the dose and the length of time you have been taking it, ask your doctor to help you set up a schedule. If the long-term use has been at high doses, stopping use requires medical supervision.

Will benzodiazepines interact with other medications?

These drugs may interact with other medications. If your doctor or dentist prescribes any medication, inform him or her about the drug you are taking. Check with your pharmacist before using any over-the-counter medication, including herbal products, cold or allergy tablets, or cough syrups.

When taken on their own, the risk of overdose with benzodiazepines is low; however, combining these drugs with other sedatives, such as alcohol, or with medications containing codeine or other opioid drugs, can result in overdose and possible death. Symptoms of overdose include slurred speech, confusion, severe drowsiness, weakness and staggering, slow heartbeat, breathing problems and unconsciousness.

What if I drink alcohol or coffee while taking benzodiazepines?

Benzodiazepines can be dangerous when combined with alcohol. Benzodiazepines increase the effects of alcohol, making you more sleepy, dizzy or lightheaded. One danger of this is the increased risk of stumbling, falling and related injuries. Another is the increased risk of overdose. Both alcohol and benzodiazepines slow down the central nervous system, which controls breathing. In overdose, breathing can stop.

Drinking too many caffeinated beverages (i.e., more than four cups of coffee or six cups of tea daily) may counteract the anxiety-reducing effects of benzodiazepines.

What if I use street drugs while taking benzodiazepines?

If you are taking benzodiazepines to help reduce the distress of a mental health problem, chances are that you want to feel less anxious and get a good night’s sleep. Street drugs, such as marijuana or cocaine, have effects that can worsen symptoms of anxiety and interfere with sleep—making you feel worse, rather than better.

Taking benzodiazepines to enhance the effect of other sedative drugs, such as opioids, is dangerous and increases the risk of overdose and injury.

Will benzodiazepines affect my ability to drive safely?

Benzodiazepines can affect your ability to drive a vehicle and increase the risk of a crash, especially if taken in combination with alcohol or other sedative drugs. The risk is highest when you first start taking benzodiazepines, before you are used to their effect. Avoid driving or operating other machinery if you feel drowsy or slowed down.

Will benzodiazepines affect my sex drive and function?

There is no clear evidence that benzodiazepines have any effect on sex drive or function.

Is it safe to take benzodiazepines while pregnant or breastfeeding?

The risk of birth defects from taking benzodiazepines while pregnant is not known, though it is thought to be very small. If benzodiazepines are used regularly close to the delivery date, the baby may be born drowsy or may have withdrawal symptoms such as restlessness and feeding problems.

Small quantities of benzodiazepines can be passed through breast milk from the mother to the baby. This may cause drowsiness in the baby.

If you are pregnant or breastfeeding, or thinking about becoming pregnant, talk to your doctor about the risks and benefits of continuing or stopping benzodiazepines. If your doctor recommends that you stop taking benzodiazepines, he or she will help you to slowly reduce your dose over time, to avoid withdrawal symptoms.

Can children and teens use benzodiazepines?

Benzodiazepines are not recommended for use by children and teens, except to bring sedation prior to surgery or for brief medical procedures. Extra caution should be used when considering giving benzodiazepines to children as these drugs may cause children to become irritable rather than calm.

Can older adults use benzodiazepines?

Sensitivity to the effects of benzodiazepines increases with age. When older adults take these drugs, they may become confused and have reduced muscle co-ordination, putting them at greater risk of falls, hip fractures and motor vehicle crashes.

If an older person has been taking benzodiazepines regularly for a very long time, the process required to stop taking them may be long and difficult. In some cases, a doctor may decide to leave the older person on the medication, with regular assessment of daytime side-effects.

Copyright © 2009, 2012 Centre for Addiction and Mental Health

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Additional Resources

  • For more information on medications, contact your doctor, nurse or pharmacist.
  • Anxiety Disorders: An Information Guide (PDF)
  • A free tutorial on anxiety disorders is available on the Mental Health 101 page.

Drugs to Treat Anxiety Disorder

Most people feel anxious at some point in their lives, and the feeling often goes away by itself. An anxiety disorder is different. If you’ve been diagnosed with one, you may need help managing anxiety. Treatment typically consists of psychotherapy and medication.

While drugs do not cure anxiety, they can help you manage your symptoms, so you can function well and feel better in your day-to-day life.

Many types of medications are available. Because every person is different, you and your doctor may have to try several medications to find the right one for you.

Benzodiazepines are sedatives that can help relax your muscles and calm your mind. They work by increasing the effects of certain neurotransmitters, which are chemicals that relay messages between your brain cells.

Benzodiazepines help treat many kinds of anxiety disorders, including panic disorder, generalized anxiety disorder, and social anxiety disorder. Examples of these drugs include:

  • alprazolam (Xanax)
  • chlordiazepoxide (Librium)
  • clonazepam (Klonopin)
  • diazepam (Valium)
  • lorazepam (Ativan)

Benzodiazepines are typically used for short-term treatment of anxiety. This is because they can increase drowsiness and cause problems with balance and memory. They can also be habit-forming. There’s an increasing number of cases of substance use disorder involving benzodiazepine.

It’s important to only use these drugs until your doctor prescribes other treatment. However, if you have panic disorder, your doctor may prescribe benzodiazepines for up to 1 year.

Side effects

In addition to drowsiness and memory problems, taking benzodiazepines can also cause:

  • confusion
  • vision problems
  • headaches
  • feelings of depression

If you’ve taken a benzodiazepine regularly for more than 2 weeks, it’s important to not stop the pills suddenly, as this could cause unwanted withdrawal symptoms. Instead, talk with your doctor about slowly tapering off your dosage to reduce your risk of seizure.

Buspirone is used to treat both short-term anxiety and chronic (long-lasting) anxiety disorders. It’s not fully understood how buspirone works, but it’s thought to affect chemicals in the brain that regulate mood.

Buspirone can take up to several weeks to become fully effective. It’s available as a generic drug as well as the brand-name drug Buspar.

Side effects

Side effects can include dizziness, headaches, and nausea. Some people also report strange dreams or difficulty sleeping when they take buspirone.

Antidepressant medications work by affecting neurotransmitters. These drugs can be used to treat anxiety symptoms, but they usually take 4 to 6 weeks to produce noticeable effects.

Types of antidepressants include:

SSRIs

Selective serotonin reuptake inhibitors (SSRIs) work by increasing levels of serotonin, a neurotransmitter that affects mood, sexual desire, appetite, sleep, and memory. SSRIs are typically started at a low dose that your doctor gradually increases.

Examples of SSRIs used to treat anxiety include:

  • escitalopram (Lexapro)
  • fluoxetine (Prozac)
  • paroxetine (Paxil)
  • sertraline (Zoloft)

Side effects

SSRIs can cause a variety of side effects, but most people tolerate them well. Side effects can include:

  • nausea
  • dry mouth
  • muscle weakness
  • diarrhea
  • dizziness
  • drowsiness
  • sexual dysfunction

If you have a concern about a particular side effect, talk with your doctor.

Tricyclics

Tricyclics work as well as SSRIs do for treating most anxiety disorders, except obsessive-compulsive disorder (OCD). It’s thought that tricyclics work similarly to SSRIs. Like SSRIs, tricyclics are started at a low dose and then increased gradually.

Examples of tricyclics used for anxiety include:

  • clomipramine (Anafranil)
  • imipramine (Tofranil)

Tricyclics are older drugs that are used less often because newer drugs cause fewer side effects.

Side effects

Side effects of tricyclics can include:

  • dizziness
  • drowsiness
  • confusion
  • urinary retention
  • nausea and vomiting
  • constipation
  • blurred vision
  • weight gain

Side effects can often be controlled by changing the dose or switching to another tricyclic.

MAOIs

Monoamine oxidase inhibitors (MAOIs) are used to treat panic disorder and social phobia. They work by increasing the number of neurotransmitters that regulate mood.

MAOIs that are FDA approved to treat depression but used off-label for anxiety include:

  • isocarboxazid (Marplan)
  • phenelzine (Nardil)
  • selegiline (Emsam)
  • tranylcypromine (Parnate)

Side effects

Like tricyclics, MAOIs are older drugs that cause more side effects than newer drugs. Some side effects include:

  • dry mouth
  • nausea
  • diarrhea
  • constipation
  • drowsiness
  • insomnia
  • dizziness

Certain medications, including SSRIs, some birth control pills, pain relievers, such as acetaminophen and ibuprofen, cold and allergy medications, and herbal supplements can react with MAOIs.

Using an MAOI with medications can dangerously increase your blood pressure and cause other potentially life threatening side effects.

Beta-blockers are most often used to treat heart conditions. They’re also used off-label to help relieve the physical symptoms of anxiety, especially in social anxiety disorder.

Your doctor may prescribe a beta-blocker such as propranolol (Inderal) to help reduce your anxiety symptoms in stressful situations, such as attending a party or giving a speech.

Side effects

Beta-blockers don’t usually cause side effects in everyone taking them.

Some potential side effects can include:

  • fatigue
  • dizziness
  • drowsiness
  • cold fingers or toes

Other side effects may include:

  • trouble sleeping
  • nausea
  • shortness of breath

There are a variety of at-home interventions that can help ease your anxiety symptoms. Several interventions can also be practiced in addition to taking medications.

Examples of these interventions include:

Exercise

Exercise can help reduce stress and enhance your overall sense of well-being, according to the Anxiety and Depression Association of America (ADAA).

It helps produce neurotransmitters known as endorphins. These neurotransmitters are your body’s natural pain relievers and can also help improve your sleep quality.

The ADAA reports that even short exercise sessions (about 10 minutes at a time) are effective in helping lift your mood.

Meditate

Taking 15-minute intervals of quiet time and meditation to focus on deep breathing and relaxation can help calm your anxiety. You can listen to music or repeat a motivational mantra on a regular basis.

Try chamomile

Sipping chamomile tea or taking a chamomile supplement might help to ease anxiety symptoms.

A 2016 double-blind study published in the Phytomedicine journal focused on individuals with generalized anxiety disorder.

The study found that study participants who took 500-milligram chamomile supplements three times per day on a daily basis reported a reduction in moderate to severe generalized anxiety.

Drinking chamomile tea has also been shown to help reduce anxiety.

Smell aromatherapy oils

Smelling diluted aromatherapy oils may help reduce anxiety, according to an article published in the Evidence-Based Complementary and Alternative Medicine journal.

Examples of essential oils used to provide anxiety relief include:

  • lavender
  • neroli
  • chamomile

Avoid caffeine

Sometimes caffeine may make you feel jittery and more anxious. Avoiding it can help some people reduce their anxiety.

Your doctor can help you find the best course of treatment for your anxiety. Proper treatment will likely include psychotherapy and medication.

Be sure to follow their instructions when taking anxiety medications and let them know about any side effects you have. Also, ask any questions you have about your condition or your treatment, such as:

  • What side effects could I have from this medication?
  • How long will it take to start working?
  • Does this medication interact with any other drugs I’m taking?
  • Can you refer me to a psychotherapist?
  • Could exercise help relieve my anxiety symptoms?

If you feel a medication isn’t giving you the desired results or is causing unwanted side effects, talk with your doctor before you stop taking it.

Mydocalm - forget about pain

Perhaps no person can say that he does not know the sensation of pain. Everyone sooner or later encounters this unpleasant phenomenon, however, nature intended that pain would be beneficial - it would stimulate us to avoid factors that are dangerous to our health or eliminate them. But even this well-established mechanism fails and pain loses its physiological significance when it becomes chronic. Constant back pain, including in the lumbar and cervical regions, joint pain - today this is by no means a sign of old age, young people are increasingly becoming its victims. Chronic pain significantly reduces the quality of life and in many cases leads to a worsening of the course of the disease. Stop enduring the pain - it's time to fight back!

Pain in the back and joints is familiar to many and can overshadow even the most joyful and carefree days. A huge number of people become victims of pain syndrome of various localization. Thus, back pain ranks 2nd in terms of the frequency of seeking medical help, second only to acute respiratory diseases. In the USA, in 52% of cases, the reason for seeking emergency care is pain (Svintsitsky A.S., 2012). According to WHO, more than 60% of the world's population experience pain in the back or joints, which leads to disability (Sitel A.B., Teterina E.B., 2006).

At the same time, almost 80% of the population complains of back pain. It should be noted that more and more often pain becomes an obsessive companion of middle-aged people (30–59 years old), who make up 2 / 3 patients with pain in the lumbar region. Today, even teenagers turn to the doctor with complaints of back pain (Nesterov O.A., 2004). The prevalence of joint pain seems no less threatening. More than 30% of Ukrainians constantly or periodically experience joint pain. At the same time, in 5% of cases, such problems lead to disability (Rudyakova S.E., 2005).

Thus, according to modern world standards, pain syndrome is one of the most significant problems, which has not only medical significance, but also negative socio-economic consequences.

Unfortunately, despite the danger of complications and discomfort, many tend to ignore the pain syndrome. We are full of optimism - a little rest and the pain will pass by itself. And only after long fights face to face with the enemy does an understanding come to us - the pain is not going to go anywhere. And then, bent over or limping, we go to the doctor.

Most often, patients complain of pain in the lumbar region. According to statistics, every 3rd inhabitant of the planet has encountered this problem at least once, about 20-40% of patients report constant pain in the lower back for many months. It is difficult to overestimate its impact on comfort and quality of life. Thus, in the US, back pain is the 2nd most common cause of disability. In about 90% of cases, this pain is non-specific, but only 1% of it signals the presence of a severe underlying disease, in the remaining 99% drug therapy should be aimed mainly at combating the pain syndrome directly (Khodinka L. et al., 2003).

For chronic back pain, both medical and physiotherapeutic methods of treatment, such as therapeutic exercises, manual therapy, are used. Among the drugs used to treat pain, it is worth noting non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, antidepressants. At the same time, patients should be informed about the need to maintain sufficient physical activity, but to avoid excessive physical and static stress, carrying heavy loads.

What is the cause of pain?

The muscles of the back experience tremendous stress every day, and they are not necessarily associated with sports or hard physical work. Even the banal daily sitting at the computer requires remarkable efforts from the back muscles, which for many hours are forced to support the entire body weight, fixing us in one position.

Another reason for the development of lumbar pain is the degenerative processes of the musculoskeletal system, accompanied by muscle spasm, which actually causes pain. At the same time, the trigger for the development of the pain syndrome is the drying of the intervertebral discs, which leads, among other things, to reflex muscle tension, as a result of which there is a local change in metabolic processes, the functioning of nerve fibers and peripheral blood circulation are disrupted.

In addition, psychosocial factors such as depression and anxiety disorders play an important role in the development of chronic back pain.

In various diseases of the joints, muscle spasm also plays a leading role. At the same time, it can be caused by pathological processes in which various components of the articular mechanism are involved.

Thus, one of the key factors in the appearance of pain in the back or joints is muscle spasm. At the same time, the body responds to pain caused by muscle spasm with even greater muscle contraction. At first, it has a protective character, since it leads to the immobilization of the affected segment, but later it leads to a deterioration in the patient's condition and chronic pain. Thus, we get a vicious circle in action: pain - muscle spasm - pain (Vorobeva O.V., 2003; Godzenko A.A., 2007). That is why one of the main targets during drug therapy is muscle spasm, the elimination of which helps to break this vicious circle.

How to say "No" to pain

Therapy aimed at reducing abnormally high muscle tone and relieving pain should include muscle relaxants that can be used in parallel with NSAIDs. This approach is supported by recommendations for the treatment of acute non-specific back pain adopted in the US and the EU, as well as in the relevant reviews of the Cochrane Society (European Guidelines For The Management Of Chronic Non-Specific Low Back Pain, 2004; van Tulder M.W. et al. 2006; van Tulder M.W. et al., 2006; American College of Physicians, 2007; American Pain Society, 2007; Malanga G., Wolff E., 2008).

To avoid worsening of the condition and an increase in the severity of back pain, one should avoid provoking factors (lifting weights, staying in an uncomfortable position for a long time, intense physical activity, etc. ), often walking, swimming or doing therapeutic exercises. It must be remembered that before training, always carry out a warm-up. And when sitting, you should make sure that the working surface of the table is at a comfortable height, the back of the chair provides good back support and its correct position.

Portrait of the perfect muscle relaxant

In order to get rid of chronic pain, a sufficiently long treatment is needed, therefore it is very important to select muscle relaxants, and, if necessary, NSAIDs with a favorable safety profile that do not have additional effects that can negatively affect the patient's quality of life. Therefore, an important requirement for muscle relaxants, in addition to high efficiency, is the selectivity of the central muscle relaxant action and, of course, a favorable safety profile.

At the same time, such a drug should reduce increased muscle tone without suppressing it so much that maintaining posture and the chosen posture becomes a problem. In addition, the use of the drug should not be an obstacle to the usual way of life, work. It is also important that it combines well with other drugs. In this context, it should be noted that central muscle relaxants have such side effects as sedation, dizziness, loss of coordination, weakness, which undoubtedly reduces patient compliance, and hence the effectiveness of treatment. The sedative effect is especially significant in this aspect, which significantly limits the use of this group of drugs.

Mydocalm - and pain under control

Significantly differs from other centrally acting muscle relaxants Mydocalm (tolperisone), developed by specialists from the Hungarian pharmaceutical company Richter Gedeon and used for more than 40 years in clinical practice by specialists in more than 30 countries of the world. In addition, its effectiveness has been proven in more than 100 studies (Godzenko A.A., 2007).

Mydocalm was originally used to reduce the severity of spastic syndrome, but for many years it has been successfully taken for inflammatory and degenerative diseases of the musculoskeletal system. This drug effectively reduces spasm and muscle tension, painful for the patient, improves motor function (Nikonov E.L. et al., 2001). Mydocalm reduces muscle tone and stiffness, thereby increasing freedom of movement in the spine and joints.

Due to its chemical structure, tolperisone, the active substance of Mydocalm, exhibits lidocaine-like activity and has a membrane-stabilizing effect, and also inhibits the conduction of nerve impulses, which leads to blocking of spinal reflexes.

Thus, this drug promotes muscle relaxation, while not affecting the implementation of voluntary movements, their coordination, and also without causing the development of sedation and muscle weakness, which was shown during a double-blind, placebo-controlled study involving 72 healthy volunteers aged 19-27 years. So, along with the good tolerability of Mydocalm, there was no difference between the groups taking Mydocalm and placebo (Pratzel H.G. et al., 1996). Thanks to this, a patient who takes Mydocalm can drive vehicles and otherwise lead a fairly active lifestyle.

It is important that during long-term therapy of various rheumatic diseases, tolperisone is able to increase the effectiveness of NSAIDs such as AERTAL (aceclofenac). This makes it possible to reduce the dose of NSAIDs, which means reducing the likelihood of side effects from the digestive tract associated with the use of drugs in this group.

Thus, the use of mydocalm in the complex therapy of osteoarthritis made it possible in 60% of cases to reduce the dose of NSAIDs and avoid the development of side effects, which is very important in the treatment of this pathology, since it often develops in patients aged 30–60 years, when the incidence of adverse events increases against the background of the use of NSAIDs (Alekseeva L.I., Bratygina E.A., Kashevarova N.G. et al., 2008).

Thus, the combination of the central muscle relaxant Mydocalm and NSAIDs can achieve significant positive results in the treatment of nonspecific chronic back pain (Waddell G., Burton A. K., 2001; Voznesenskaya T.G., 2001; Povoroznyuk V.V., 2004). The clinical efficacy and favorable safety profile of mydocalm have also been confirmed in the treatment of degenerative joint diseases (Grodzenko A.A., 2007).

The results of a study involving patients with pain syndrome due to the development of muscle spasm on the background of rheumatic diseases indicate the successful use of tolperisone. Thus, tolperisone acts on a wide range of causes of pain formation (Alekseeva L.I., Bratygina E.A., Kashevarova N.G. et al., 2008). In addition, it has been proven that with mydocalm as part of complex therapy for osteochondrosis of the spine, the severity of symptoms, including pain, decreases faster (Sitel A.B., Teterina E.B., 2006).

Mydocalm is available in the form of film-coated tablets (50 and 150 mg each) and an injection solution. At the same time, it was noted that in patients with acute back pain, Mydocalm, administered parenterally, shows an effect after the first injection (Avakyan G. N. et al., 2000), and after a week the patient's quality of life is significantly improved, which reduces the treatment period. .

Thus, many years of experience in the use of mydocalm in clinical practice, a complex mechanism of action, along with efficacy and a favorable safety profile, allow it to be taken both as monotherapy and in combination with other drugs, in particular NSAIDs such as Airtal.

Evgenia Lukyanchuk

ranking of the top 10 inexpensive and effective remedies according to the KP with doctors' reviews

Muscle relaxants is a general name for a number of drugs that, due to the action of one or another active substance, allow you to relax skeletal muscles up to complete immobility. Such drugs are used in the treatment of various diseases, as well as for diagnostic purposes, when it is necessary for a person to be conscious, and his muscles should not contract.

Muscle relaxants help reduce excess tension in the lower back, relieve increased muscle tone in patients who have had a stroke, after a traumatic brain or spinal injury, with multiple sclerosis 1 and a number of other diseases.

There are muscle relaxants of central and peripheral action. The former inhibit the process of excitation in the central nervous system and suppress reflexes. The latter do not affect the neurons of the brain, but act directly on the points of contact of the muscles with the nerve endings.

Important benefits of using muscle relaxants 2 :

  • relieve muscle tension,
  • reduce pain,
  • improve motor activity,
  • reduce the dose of painkillers and increase their effect.

Muscle relaxants can be used in combination with analgesics and NSAIDs (non-steroidal anti-inflammatory drugs), as well as in combination with acupuncture and exercise therapy 1 .

Muscle relaxants have a number of contraindications and side effects. Often while taking the drug there is drowsiness, fatigue, dizziness, lethargy. This must be taken into account when choosing a medicine, so you can not do without a preliminary consultation with a doctor.

Rating of the top 10 inexpensive and effective muscle relaxants according to KP

Drugs with different names can be purchased in pharmacies, but 3 active ingredients are most often used in their composition: baclofen, tolperisone or tizanidine. The choice of one or another muscle relaxant depends on the purpose, the presence of contraindications and possible side effects. We will consider the most popular and safe muscle relaxants recommended by doctors.

1. Baklosan

Baklosan

The drug is available in tablets of 10 and 25 mg. Designed to reduce muscle tone in multiple sclerosis, diseases of the spinal cord (tumors, syringomyelia, trauma, etc.) and cerebrovascular diseases, cerebral palsy, meningitis, traumatic brain injury.

Active ingredient - baclofen - effectively relieves painful spasms. The drug is prescribed even for children older than 3 years.

However, there is a wide range of contraindications, which, in addition to hypersensitivity, include: epilepsy, convulsions, psychosis, Parkinson's disease, gastric and duodenal ulcers, lactase deficiency, lactose intolerance, pregnancy and lactation.

fast effect, low price in the segment.

an impressive list of side effects.

2. Tolperisone

Tolperisone

The drug was developed in the middle of the last century and during this time has demonstrated its effectiveness and safety 3 . Tolperisone does not affect the peripheral parts of the nervous system, it has an analgesic and vasodilating effect.

Tolperisone is prescribed for the treatment of spinal and cerebral palsy, diseases with severe muscle tension and spasm, rheumatic diseases, epilepsy and a number of other diseases.

It is not recommended to use the drug in case of hypersensitivity to the components, myasthenia gravis, as well as in pregnancy, breastfeeding and children under 18 years of age.

Important: for one course (regardless of the prescribed treatment) you will need several packs of the drug. In one - only 30 tablets of 50 mg.

side effects are rare, which is a big plus for muscle relaxants.

not suitable for children, uneconomical packaging.

3. Tizanidine

Tizanidine tab. . Photo: market.yandex.ru

Another muscle relaxant that can be used in the treatment of painful muscle spasms, muscle hypertonicity in multiple sclerosis, diseases and injuries of the spinal cord.

There is no universal regimen here - everything depends on the disease itself and the health characteristics of each patient. Therefore, the dosage regimen and dosage will be prompted only by the attending physician.

In addition to hypersensitivity to components, lactase intolerance/deficiency, and pregnancy, severe liver dysfunction is on the list of contraindications. It is not recommended to use the drug for lactating women and children under 18 years of age.

Among the "side effects" are often muscle weakness, drowsiness, dizziness, dry mouth, increased fatigue.

low price in the segment, quick effect.

common side effects.

4. Tolizor

Tolizor

Domestic generic Tolperisone is available in the form of capsules of 50 and 150 mg. It is recommended for the treatment of diseases and pathologies associated with increased skeletal muscle tone.

The list of contraindications is the same as for other muscle relaxants. In addition, the drug should be used with caution in people with hypersensitivity to lidocaine and in patients with renal and hepatic insufficiency. Side effects (weakness, drowsiness) are quite rare.

Important: the drug should be taken strictly after meals. On an empty stomach, the medicine is absorbed worse by the body, and there will be no effect.

small risk of side effects.

uneconomical packaging, which ultimately affects the cost.

5. Mydocalm

Mydocalm tab. Photo: market.yandex.ru

The drug contains a substance already familiar to readers - tolperisone. It is used to relax skeletal muscles in various neurological, orthopedic and other diseases accompanied by muscle hypertonicity (for example, multiple sclerosis, myelopathy, encephalomyelitis), cerebral palsy.

Do not take this muscle relaxant if you have a history of myasthenia gravis, severe kidney and liver disease, hypersensitivity to drug substances, lactose intolerance/insufficiency, pregnant or lactating women.

But for children from the age of 3, the drug is allowed, but only in the form of tablets of 50 mg.

is approved for use in children (from 3 years of age).

high cost.

6. Kalmirex

Kalmirex

Tablets contain the active substance Tolperisone. The drug is intended for the treatment of increased muscle tone after a stroke, with muscle spasm, accompanied by pain. This muscle relaxant can only be used by adults and on prescription.

Contraindications: hypersensitivity to components, myasthenia gravis, lactose intolerance/deficiency, breastfeeding.

Use with caution in people with renal and hepatic insufficiency - the risk of adverse events is high. In general, side effects (drowsiness, fatigue, weakness, dizziness) are rare.

broad spectrum of activity, rare side effects.

You will need several packs per course (only 30 tablets in one pack).

7. Sirdalud

Sirdalud. Photo: market.yandex.ru

Tizanidine is a popular muscle relaxant. It is quite effective for painful muscle spasms associated with diseases of the spine (cervical, lumbar syndromes), with multiple sclerosis and chronic myelopathy, and can also be used after surgical interventions (for example, during rehabilitation after removal of a spinal hernia) 4 .

Sirdalud tablets can be divided in half and taken in parts, since correct dose selection is very important, but this is not always convenient.

broad spectrum, high efficiency.

Inconvenient receive mode.

8. Lioresal Intrathecal

Lioresal Intrathecal

The muscle relaxant, the active ingredient of which is baclofen, is produced in the form of a solution for injection directly into the spinal cord, and therefore is used only in a hospital setting.

The drug is recommended for people with chronic muscle spasm caused by damage to the brain or spinal cord. The medicine helps to reduce pain during spasms, reduces cramps and twitches. As a result, physical activity increases, sleep improves, and the work of the bladder normalizes.

There are also disadvantages: the drug can cause drowsiness, respiratory depression and the work of the cardiovascular system.

quick effect, improves the quality of life of bedridden patients, suitable for those who find it difficult to swallow tablets and capsules.

difficult to find commercially, frequent side effects.

9. Tolmio

Tolmio. Photo: market.yandex.ru

An injectable drug (can be administered both intramuscularly and intravenously) helps reduce increased muscle tone, dilates blood vessels, reduces pain and spasms, and lidocaine has a local anesthetic effect.

Tolmio is used in diseases accompanied by painful muscle spasms, as well as muscle hypertonicity in stroke.

Do not use Tolmio in the presence of the following contraindications: hypersensitivity to the components, severe myasthenia gravis, pregnancy and breastfeeding, children's age (under 18 years). Patients with renal and hepatic insufficiency - with caution and only on the recommendation of the attending physician. Side effects after taking the drug are rare or infrequent.

minor side effects, suitable for patients with difficulty in swallowing.

is difficult to find on sale, high price in the segment.

10. Thezalud

Thezalud. Photo: market.yandex.ru

A muscle relaxant based on tizanidine can help relax muscles and reduce pain from spasms associated with diseases of the spine, after surgery and in neurological diseases such as multiple sclerosis, degenerative diseases of the spinal cord, cerebral palsy (but only from 18 years).

The use of Tizalud is also contraindicated in case of hypersensitivity to the components of the drug (including lactose), severe liver dysfunction, during breastfeeding. Do not simultaneously use this drug with the antidepressant fluvoxamine and the antibiotic ciprofloxacin (and analogues). Patients over 65 years of age and patients with hepatic and renal insufficiency should first consult a doctor.

Do not forget that you need to strictly regulate the dosage of tizanidine, so the tablets will have to be divided into small parts.

wide range of action, low price in the segment.

inconvenient format for taking (you need to divide the tablets into parts for the correct dosage).

How to choose muscle relaxants

The choice of the drug should be treated with particular care, given its purpose. Despite the common "target" - spasm, the list of diseases may vary. It is also important to study the list of contraindications and restrictions.

Many muscle relaxants are "rich" in side effects, which may occur with varying degrees of probability, and this must also be taken into account.

Undoubtedly, only a doctor can choose the optimal drug in each case. That is why muscle relaxants are prescription drugs so that a person does not harm himself by self-medicating.

If you think you need a muscle relaxant, ask your doctor about this. Don't forget to indicate your health conditions (allergies, sensitivity to lactose, lidocaine and other substances, etc.).

Doctors' opinions about muscle relaxants

Despite the rather long history of the use of muscle relaxants, the opinions of doctors about their appointment still differ.

Some experts recommend the use of muscle relaxants for back pain.

- When used correctly, muscle relaxants significantly improve the quality of life of patients, - notes a neurologist of the highest category Olga Lisenkova .

Other doctors consider this treatment inappropriate 5 . A number of physicians are convinced that research data on the effectiveness of muscle relaxants is not enough, so they do not need to be prescribed.

Popular questions and answers

How muscle relaxants work and why they need to be used with great care, answers a neurologist of the highest category Olga Lisenkova.

When are muscle relaxants used?

- Muscle relaxants ("myo" - muscle, "relax" - relaxation) - a large group of drugs used when muscles need to be relaxed. They are used in anesthesiology (for anesthesia), for back pain (in the form of tablets and injections), for spasticity - this is a painful muscle spasm that occurs with diseases of the nervous system. Spasticity occurs after a stroke, traumatic brain injury, with multiple sclerosis and other diseases.

Why are muscle relaxants dangerous?

— Like all medicines, muscle relaxants have side effects. Overdose may cause excessive muscle weakness, heart rhythm disturbances, dizziness, etc.

How many days can muscle relaxants be taken?

— The course of treatment depends on the diagnosis and condition of the patient. Muscle relaxants can be taken from a few days (for back pain) to a constant daily intake for many years. For example, the drug baclofen can be administered using a so-called "baclofen pump" - a device that is implanted in the human body and releases the drug into the spinal canal.

Why can't muscle relaxants be used without a doctor's prescription?

- These are serious drugs with a lot of side effects and contraindications. The effect often depends on the dose, which is selected individually. It is also very important to consider the risk of interactions with other drugs. Without a doctor, all this is unlikely to be sorted out.

What can replace muscle relaxants if you have neck or lower back pain?

— The two most common triggers for neck and lower back pain are stress and sedentary work. Therefore, the best replacement for muscle relaxants is a good psychological preparation and physiotherapy exercises. A positive result gives a manual or hardware massage.

Sources:

  1. O. Kotova, A. Artemenko, E. Akarachkova, A. Belyaev. The use of muscle relaxants for nonspecific pain in the lower back // Vrach. 2018. No. 9. pp. 13-16 https://cyberleninka.ru/article/n/primenenie-miorelaksantov-pri-nespetsificheskoy-boli-v-nizhney-chasti-spiny/viewer
  2. N.

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