Zanastad

Rx

Indications

• Symptomatic treatment of spasticity associated with multiple sclerosis or with spinal cord injury.
• Muscle spasm or clonus.
• Painful muscle spasm.

Dosage

Adults

• Treatment of spasticity: The usual initial dose: 2 mg, given as a single dose. The dose may be increased thereafter according to patient’s response in steps of 2 mg at intervals of at least 3 to 4 days, usually up to 24 mg daily given in 3 or 4 divided doses. The maximum recommended dose is 36 mg daily.
• Treatment of painful muscle spasm: 2 – 4 mg three times daily.

Patients with renal impairment (creatinine clearance < 25 ml/min)

• Treatment should be started with 2 mg once daily, gradually increasing. Dosage increases should be in increments of no more than 2 mg. Slow increase the once-daily dose before increasing the frequency of administration. Renal function should be monitored.

Safety and efficacy of tizanidine towards children have not been established.

Usage

• Zanastad is administered orally with a relatively short duration of action therefore it should be given in divided doses daily (up to 3 – 4 times daily), depending on the patient’s needs. Dosage should be adjusted according to patient’s response. Do not exceed the doses producing the desired therapeutic effects.
• Zanastad may be taken with or without food, but not change the way you take it, switch from fed to fasted states may delay or more rapid onset of activity and increased adverse effects.

• Hypersensitivity to any of the ingredients.
• Concomitant therapy with ciprofloxacin or fluvoxamine.
• Severe hepatic impairment.

Common

• Dry mouth, abdominal pain, diarrhea, dyspepsia;
• Myasthenia, back pain;
• Somnolence, drowsiness, fatigue, vertigo, depression, anxiety, paresthesia, hallucinations;
• Rash, sweating, skin ulcer;
• Fever.

• Zanastad prolongs of the QT interval producing bradycardia, produce hypotension. Hypotensive effect depends on dose and occurs after a single dose ≥ 2 mg. When the posture is suddenly altered, the risk of orthostatic hypotension may be increased.
• Zanastad may produce hepatic damage, so extreme caution should be exercised in patients with impaired hepatic function. Monitoring of serum aminotransferase concentrations should be performed during the first 6 months of treatment (e.g., at 1, 3, and 6 months) and periodically thereafter depending on clinical condition.
• Zanastad may produce hallucinations in some patients receiving this drug.
• Caution should be exercised when using Zanastad in patients with renal impairment with a creatinine clearance less than 25 ml/minute.
• Zanastad should only be used when the benefit is clearly considered to outweigh the risk in the elderly patients. This drug is not recommended for use in children.
• Drug should not be stopped abruptly because of rebound hypertension, tachycardia and hypertonia; doses should be decreased slowly, particularly in patients receiving high doses for prolonged periods.
• Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take Zanastad.
• Zanastad should only be used during pregnancy if clearly necessary. Drug should only be used in nursing women when the benefit is clearly considered to outweigh the risk.
• Zanastad has sedative effect and may induce somnolence, caution should be used in patients requiring alertness, e.g. driving a vehicle and operating machinery.