Indication:Spasticity due to MS or head injury
Refer to NICE CG 186
NICE CG186 Management of MS in Primary & Secondary Care:
Prescribing Guidance for Tizanidine 2.3.11
1. The prescribing specialist completes neurological assessment of patient, arranges for baseline LFT, FBC and urinalysis and provides patient with an information pack on tizanidine, and support literature on spasticity.
2. Prescriptions will continue to be provided by the prescribing specialist until dose is effective and stable, or 4 months whichever is the longer.
3. The prescribing specialist is to order and follow up LFT monitoring on a monthly basis for the first 4 months.
4………………………… Clinic letter to be sent by specialist service to GP to inform them of patients need for continuing treatment.
5. Once Step 4 has been completed, patients will be asked to contact their GP for future prescriptions.
6. The prescribing specialist will arrange to follow up patient as required.
Tizanidine has a number of interactions with other medications, particularly those that are inhibitors of the CYP450 system (and specifically those that inhibit CYP1A2 within the CYP450 system). Examples of drugs involved are detailed below, however this is not a complete list and full details should be obtained from the SPC at http://www.medicines.org.uk/emc/
Tizanidine is contra-indicated with ciprofloxacin due to risk of increased quinolone levels
It is not recommended to be used with amiodarone, cimetidine, propafenone, norfloxacin and oral contraceptives.
In addition, it is to be used with caution with alpha-blockers, digoxin and medication that prolong the QT interval (sotalol, amiodarone, TCAD’s, SSRI’s, haloperidol, macrolides, quinolones, tamoxifen, azole antifungals, terbinafine, diltiazem and verapamil). The clinical significance of the listed drugs varies and full guidance should be obtained from the relevant SPC at http://www.medicines.org.uk/emc/
Tizanidine also may cause hypotension and thus may potentiate the effect of commonly used hypertensive medication.
Tizanidine must not be stopped abruptly due to the risk of rebound hypertension.
Doncaster & Bassetlaw Area Prescribing Committee
Doncaster & Bassetlaw Hospitals Foundation Trust