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Drugs to treat muscle spasms and spasticity

The spasming, sore muscles that can be the culprit behind back and neck aches and other conditions can leave many people reaching for a strong medicine to ease their pain, as evidenced by the more than $1 billion in U.S. sales potent muscle relaxant drugs racked up last year. But our latest Best Buy Drug report recommends that your best first option for relief from these conditions is a common over-the-counter pain reliever, such as acetaminophen (Tylenol and generics), aspirin, ibuprofen (Advil and generics), or naproxen (Aleve and generics). The muscle relaxants are no better than these nonprescription pain relievers and they carry dangerous side effects, such as addiction and sedation.

Where muscle relaxants could be a good first option is the treatment of muscle spasticity associated with disorders such as cerebral palsy, multiple sclerosis or stroke. Due to the seriousness of these conditions, the benefits of the drugs may be worth the potential risks and consequently, the medicines are considered first line therapy for spasticity triggered by these disorders.

The sections below give our Best Buy recommendations for each condition.

Muscle spasticity
Damage to the brain or spinal cord from diseases such as cerebral palsy and multiple sclerosis can interfere with normal muscle relaxation and result in involuntary muscle contractions that can be very painful and impair your ability to walk, sleep, work or just function normally. Severe cases can result in profound disability, including an inability to straighten out joints. Three of the nine available muscle relaxants are FDA approved for treating spasticity.

Taking into consideration all of the evidence on muscle relaxants for spasticity, our Best Buy pick is:

  • Generic baclofen tablet

Baclofen costs between $27 and $60 for a 30-day supply, so you could save a significant amount of money over some of the more expensive brand-name muscle relaxants, which can cost from $200 to up to $486 a month.

Muscle spasms
Muscle spasms, on the other hand, are associated with much more common conditions that affect the muscles, bones and associated tissues, including headaches, back and neck aches, and fibromyalgia. The spasms can be very painful and reduce your ability to function. If you have muscle spasms due to one of these conditions that have not responded to nondrug therapies, then over-the-counter pain relievers--acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen or naproxen-- are a reasonable first option. But if these don't work or you can't tolerate acetaminophen or NSAIDs because of liver problems, bleeding ulcers or heart issues, then you may want to consider trying a muscle relaxant.

If you and your doctor have decided to try a muscle relaxant to treat muscle spasms, taking all of the evidence into consideration, we chose the following as a Best Buy:

  • Generic cyclobenzaprine tablet

Cyclobenzaprine is supported by the strongest body of evidence. Also, it is available in a generic form that costs $8 to $15 for a seven-day course, which makes it one of the least expensive generic muscle relaxants and significantly less costly than brand-name ones that can run more than $100.

We recommend avoiding carisoprodol (Soma) because it is associated with a high risk of abuse and addiction potential not seen with other skeletal muscle relaxants. Despite these risks, it is a widely used medicine and one of the top-selling muscle relaxants, racking up $204 million in sales of the generic drug last year, according to SDI/Verispan.

In addition to sedation, the most common side effects associated with muscle relaxants include weakness or fatigue, dizziness, and dry mouth.

Last updated December 2009

Drugs to treat muscle spasms and spasticity - Drug Comparison
CR Best Buy Generic Name and Dose Brand Name Typical Dosing Schedule1 Approved Indication1 Average cost per 30 days of use (for spasticity) or per 7 days of use (for muscle spasms)2 Compare Prices
Baclofen 10 mg tablet Generic Three times daily Spasticity $27
Baclofen 20 mg tablet Generic Three times daily Spasticity $60
  Carisoprodol 250 mg tablet Soma Three times daily Spasms $84
  Carisoprodol 350 mg tablet Soma Three times daily Spasms $147
  Carisoprodol 350 mg tablet Generic Three times daily Spasms $11
  Chlorzoxazone 500 mg tablet Parafon Forte DSC Three-four times daily Spasms $63-$84
  Chlorzoxazone 500 mg tablet Generic Three-four times daily Spasms $8-$11
  Cyclobenzaprine 5 mg tablet Flexeril Three times daily Spasms $42
  Cyclobenzaprine 10 mg tablet Flexeril Three times daily Spasms $42
  Cyclobenzaprine 7.5 mg Fexmid Three times daily Spasms $105
Cyclobenzaprine 5 mg Generic Three times daily Spasms $15
Cyclobenzaprine 10 mg Generic Three times daily Spasms $8
  Cyclobenzaprine 15 mg continuous delivery capsule Amrix Once daily Spasms $91
  Cyclobenzaprine 30 mg continuous delivery capsule Amrix Once daily Spasms $91
  Dantrolene 25 mg capsule Dantrium Three-four times daily Spasticity $138-$184
  Dantrolene 50 mg capsule Dantrium Three-four times daily Spasticity $165-$220
  Dantrolene 100 mg capsule Dantrium Three-four times daily Spasticity $231-$308
  Dantrolene 25 mg capsule Generic Three-four times daily Spasticity $111-$148
  Dantrolene 50 mg capsule Generic Three-four times daily Spasticity $153-$204
  Dantrolene 100 mg capsule Generic Three-four times daily Spasticity $198-$264
  Metaxalone 400 mg tablet Skelaxin Three times daily Spasms $42
  Metaxalone 800 mg tablet Skelaxin Three times daily Spasms $105
  Methocarbamol 500 mg tablet Robaxin Four times daily Spasms $56
  Methocarbamol 750 mg tablet Robaxin-750 Four times daily Spasms $56
  Methocarbamol 500 mg tablet Generic Four times daily Spasms $11
  Methocarbamol 750 mg tablet Generic Four times daily Spasms $14
  Orphenadrine 100 mg tablet Norflex Twice daily Spasms $42
  Orphenadrine 100 mg tablet Generic Twice daily Spasms $28
  Tizanidine 2 mg tablet Zanaflex Three times daily Spasticity $195
  Tizanidine 4 mg tablet Zanaflex Three times daily Spasticity $249
  Tizanidine 2 mg capsule Zanaflex Three times daily Spasticity $249
  Tizanidine 4 mg capsule Zanaflex Three times daily Spasticity $324
  Tizanidine 6 mg capsule Zanaflex Three times daily Spasticity $486
  Tizanidine 2 mg tablet Generic Three times daily Spasticity $81
  Tizanidine 4 mg tablet Generic Three times daily Spasticity $72
  Carisoprodol/aspirin 200/ 325 mg tablet Carisoprodol CPD Three times daily Spasms $42
  Carisoprodol/aspirin/codeine 200/325/16 mg tablet Carisoprodol CPD with codeine Three times daily Spasms $42
  Methocarbamol/aspirin 400/325 mg tablet Generic Three times daily Spasms $13
  Orphenadrine/aspirin/caffeine 50/770/60 mg tablet Norgesic forte Three times daily Spasms $63
  Orphenadrine/aspirin/caffeine 25/385/30 mg tablet Orphenadrine compound Three times daily Spasms $42
  Orphenadrine/aspirin/caffeine 50/770/60 mg tablet Orphenadrine compound Three times daily Spasms $63-$84
1. As typically prescribed. The dose ranges and the drug's FDA approved indication are derived from drug-labeling information.

2. Prices reflect the nationwide retail average for August 2009, rounded to the nearest dollar. Information is derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Health, Pharmaceutical Audit Suite®. Wolters Kluwer Health is not involved in our analysis or recommendations.