Naproxen With Cyclobenzaprine, Oxycodone Acetaminophen, or Placebo for Treating Acute Low Back Pain: A Randomized Clinical Trial Pain Medicine JAMA

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Naproxen With Cyclobenzaprine, Oxycodone Acetaminophen, or Placebo for Treating Acute Low Back Pain: A Randomized Clinical Trial Pain Medicine JAMA

However, the gist here is that these two are considered generally safe to be taken together. In this post, we’ll go over why you might want to avoid mixing the two drugs. The goal of pharmacotherapy is to reduce pain and inflammation. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Main Outcomes and Measures The primary outcome was improvement in RMDQ between ED discharge and 1 week later. Do not use the extended-release capsules if you have used an MAO inhibitor (MAOI) such as Eldepryl®, Marplan®, Nardil®, or Parnate® within 14 days of each other.

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If your doctor prescribes an antidepressant for your pain, give it a try for several weeks. The drug will need to build up in your system in order to have maximum effect. If an antidepressant helps to some degree but you still have pain, talk to a healthcare provider about incorporating a medication from another drug class into your treatment plan. Common side effects of cyclobenzaprine include drowsiness and dizziness.

Cyclobenzaprine (Flexeril) vs. naproxen (Aleve)

Take this medication by mouth with or without food as directed by your doctor. Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information. A few types of antidepressants can be used for nerve pain, including tricyclic antidepressants, which include Amitriptyline (Elavil), Doxepin (Sinequan), and Nortriptyline (Pamelor). Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor) can also be used for pain, as can selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) (19).

They were randomized to receive either 60 tablets of placebo; cyclobenzaprine, 5 mg; or oxycodone, 5 mg/acetaminophen, 325 mg. Participants were instructed to take 1 or 2 of these tablets every 8 hours, as needed for LBP. They also received a standardized 10-minute LBP educational session prior to discharge. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur.

  • Quiz Ref IDOur results show that that adding cyclobenzaprine or oxycodone/acetaminophen to naproxen does not improve pain at 7-day or 3-month follow-up.
  • Clinicians will need to treat 3 patients to improve the symptoms of 1.
  • Most MAO inhibitors should also be avoided for two weeks before starting this medication.
  • Ask your pharmacist any questions you have about refilling your prescription.
  • Evidence suggests that the net effect of cyclobenzaprine is a reduction of tonic somatic motor activity, influencing both gamma (γ) and alpha (α) motor systems.
  • For example, providers sometimes prescribe diazepam to treat anxiety and seizures.

The efficacy of FLEXERIL 5 mg was demonstrated in two seven-day, double-blind, controlled clinical trials enrolling 1405 patients. One study compared FLEXERIL 5 mg and 10 mg t.i.d. to placebo; and a second study compared FLEXERIL 5 mg and 2.5 mg t.i.d. to placebo. Primary endpoints for both trials were determined by patient-generated data and included global impression of change, medication helpfulness, and relief from starting backache.

Ibuprofen (Ibuprin, Advil, Motrin)

Many ED patients had already taken NSAIDs for LBP before arriving to the ED. Some patients may have taken insufficient doses at incorrect intervals and could be helped by optimization of their NSAID regimen. However, for patients who have already optimized their NSAID regimen, there are no additional evidence-based medical therapies available. Quiz Ref IDOur results show that that adding cyclobenzaprine or oxycodone/acetaminophen to naproxen does not improve pain at 7-day or 3-month follow-up.

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In a pharmacokinetic study of sixteen subjects with hepatic impairment (15 mild, 1 moderate per Child-Pugh score), both AUC and Cmax were approximately double the values seen in the healthy control group. Based on the findings, FLEXERIL should be used with caution in subjects with mild hepatic impairment starting with can flexeril 10 mg be cut in half the 5 mg dose and titrating slowly upward. Due to the lack of data in subjects with more severe hepatic insufficiency, the use of FLEXERIL in subjects with moderate to severe impairment is not recommended. In patients with CNS depression, early intubation is advised because of the potential for abrupt deterioration.

Do not take more of it and do not take it more often than your doctor ordered. This medicine is available only with your doctor’s prescription. Muscle relaxers have a potential for misuse and addiction, especially carisoprodol and diazepam. Prolonged use can lead to increased tolerance and physical dependence. Baclofen is considered the first-line treatment for spasticity, especially for adults who have spinal cord injuries. This medication has been prescribed for your current condition only.

Diseases & Conditions

Additional data for the exploratory outcomes of pain intensity at one week follow-up and resumption of usual activities at three month follow-up are reported in eTable 2 in Supplement 2. During a 30-month period beginning in April 2012, a total of 323 patients were enrolled (Figure). Baseline characteristics were not different between the 3 groups (Table 1). Baseline scores on the RMDQ were high in all 3 study groups, indicating substantial functional impairment at baseline.

However, since Flexeril has properties that suppress pain, people may overuse it to amplify those feelings. The activity of Flexeril that depresses the Central Nervous System (CNS) makes it potentially addictive and dangerous. You are encouraged to report negative side effects of prescription drugs to the FDA.