Cyclobenzaprine, known by the brand names Flexeril and Amrix, is a muscle relaxant that is primarily used to relieve pain and muscles spasms associated with musculoskeletal disorders and conditions. Very often these issues have to do with back pain. Cyclobenzaprine also has off-label uses for the treatment of tension and migraine headaches, insomnia, and tinnitus (ringing in the ears). Cyclobenzaprine is typically used in conjunction with physical therapy and not intended to be a long-term treatment option. Cyclobenzaprine is not effective for treating muscle spasms associated with central nervous system conditions, such as a brain or spinal cord injury or multiple sclerosis.
Cyclobenzaprine is available in a tablet form, powder form, and capsule form (and extended-release capsule form known by the brand name Amrix). In most treatment cases, the drug is taken in a very small dosage of around 5 mg three times a day or in some cases the dosage may be increased to 10 mg three times a day.
Cyclobenzaprine is not considered to be effective for periods longer than 2-3 weeks and typically the medication is discontinued well before that time period.
The Addictive Potential of Cyclobenzaprine
Cyclobenzaprine is chemically very similar to the family of drugs known as tricyclic antidepressants. Its primary action occurs in the brain stem and at the spinal cord, and it is believed to be involved in the release of the neurotransmitter norepinephrine.
Most of the information regarding cyclobenzaprine abuse indicates that it is abused in conjunction with other drugs to enhance their effects, such as alcohol, benzodiazepines, narcotic pain medications, etc. This practice can create a potentially dangerous situation that may leave individuals open for overdosing on these types of drugs.
As a result of cyclobenzaprine’s similarity to tricyclic antidepressants, there is a potential for a mild withdrawal syndrome to develop similar to withdrawal symptoms associated with antidepressants. Abrupt discontinuation of cyclobenzaprine may produce symptoms of nausea, headaches, and general feelings of discomfort or malaise. There is no formal timeline established for any withdrawal syndrome for cyclobenzaprine; however, in general, one can expect the following:
- There is a very low probability that one will develop withdrawal symptoms from using cyclobenzaprine. The percentage of individuals experiencing withdrawal symptoms is probably well below 20 percent of all users.
- One to two days after stopping cyclobenzaprine, a person may begin to feel symptoms of headaches, nausea, and general feelings of irritability or discomfort.
- Symptoms may extend for a week or two and typically will peak in 3-4 days.
- Withdrawal symptoms from cyclobenzaprine are typically mild and not considered to be potentially physically dangerous; however, there may be rare cases where individuals will experience more severe symptoms.
Some sources refer to the above symptoms as a cyclobenzaprine discontinuation syndrome, much like the syndrome associated with antidepressant withdrawal. Even though cyclobenzaprine can only be purchased with a prescription, it does not appear to be a major drug of abuse by itself, and it is not listed in the Drug Enforcement Administration’s schedule of controlled substances. Because cyclobenzaprine is commonly abused with other drugs, such as alcohol or narcotic medications, that have a very high potential for the development of physical dependence, individuals discontinuing use of cyclobenzaprine and their other drug of choice may experience withdrawal symptoms that are associated with these other types of drugs. In addition, a number of factors can contribute to the appearance and presentation of any withdrawal syndrome associated with discontinuing cyclobenzaprine, such as the amount of the drug regularly used, the length of time taking the drug, and individual differences in physical and emotional makeup. Some sources suggest that withdrawal symptoms associated with cyclobenzaprine represent more of the psychological type of withdrawal symptoms that include irritability, mood swings, a lack of motivation, and so forth.
Even though cyclobenzaprine does not appear to produce serious physical dependence, there is a potential for the drug to produce sedation and enhance the effects of other drugs. In addition, other mild sedatives, such as Soma, have been classified by the Drug Enforcement Administration as controlled substances, and cyclobenzaprine and Flexeril abuse has increased following these actions. For example, the Substance Abuse and Mental Health Services Administration reported that there was an increase of nearly 90 percent in the number of emergency department visits in the United States between the years 2004 to 2011 due to the abuse drugs that also involved using Flexeril.
Signs of Abuse
If someone is suspected of abusing cyclobenzaprine, there are some general signs and symptoms that one can look out for:
- Anyone taking cyclobenzaprine without a prescription or taking cyclobenzaprine more than prescribed could be abusing the drug.
- Mixing cyclobenzaprine with other drugs or substances is a sure sign of abuse.
- The person appears to have lost interest in activities that they normally enjoy.
- The person becomes defensive or angry when questioned about the use of cyclobenzaprine or uses the drug in secret.
- The person seems less concerned with personal appearance.
- The person begins to ignore personal responsibilities, such as obligations to family, work, close friends, or other social obligations.
- Empty prescription containers are present.
- The person begins seeing multiple doctors in an effort to get multiple prescriptions.
- The individual wants to quit using cyclobenzaprine but is unable to do so.
- The individual begins to experience psychological or physical issues associated with use of cyclobenzaprine but is unable to cut down on their use of the drug.
Treatment for any substance use disorder should be very comprehensive. This is particularly important when there is a potential for an individual to have issues with multiple drugs of abuse at the same time (polydrug abuse). Individuals who are suspected of abusing cyclobenzaprine should be thoroughly assessed by an experienced, licensed, mental health worker for the presence of co-occurring substance abuse and other psychological disorders. The course of treatment will be dependent on any co-occurring or comorbid issues involved. In general, treatment should include:
- The option for inpatient treatment: In the initial stages of recovery, inpatient care can assist individuals with substance use disorders to negotiate the withdrawal process and remove themselves from potentially toxic environments that can lead to relapse. Because cyclobenzaprine is not considered to be a drug with the potential for significant physical dependence, inpatient treatment for cyclobenzaprine abuse would most likely be considered if the individual was abusing another drug with the potential for physical dependence or if they need to be removed from an environment that might influence their ability to remain drug-free.
- Therapy, either in an individual or group format: Therapy allows for the identification and dissection of issues that foster one’s substance use disorder, the development of new skills that are more conducive to sobriety, the development of a solid relapse prevention program, and the opportunity for self-discovery.
- Social support: This can come in the form of 12-Step groups, family therapy, or other support groups.
- Medically assisted treatment interventions: These help address substance use disorders to other drugs, psychological disorders, and any physical illnesses or disorders that need attention.
- Other specialized services: For example, some individuals may need vocational counseling, physical or occupational therapy, special psychoeducation groups, academic counseling, and so forth.
- The opportunity to participate in long-term and continuing treatment interventions: These can assist the individual in maintaining recovery on a long-term basis. This can be in the form of 12-Step group participation, other social support group participation, and/or continued group or individual therapy.