Tizan (Tizanidine Hydrochloride)
Also sold as: Tizan, Zanaflex, Sirdalud, Tizafen, Tizap
Pregnancy
Cat C
Lactation
Unknown
Schedule
H
Forms
Tablet 2mg, 4mg
Indications
- Spasticity associated with multiple sclerosis, cerebrovascular accident (stroke), spinal cord injury
- Acute painful muscle spasm (neck pain, low back pain) — short-term
- Spasm in neuromuscular disorders
Adult Dosing
Spasticity (MS, SCI, CVA)
Start 2 mg PO TDS; increase by 2 mg every 3–4 days to response. Usual: 12–24 mg/day in 3–4 divided doses.
Maximum 36 mg/day (higher doses: more side effects). Titrate slowly to minimise hypotension.
Acute muscle spasm (back/neck pain)
2–4 mg PO TDS for up to 2 weeks
Short-term only
Pediatric Dosing
Limited paediatric safety data
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl < 25 mL/min | Reduce dose — slower titration (start 2 mg OD or BD, titrate by 2 mg increments over longer intervals) |
Hepatic Adjustment
AVOID in significant hepatic impairment — hepatic metabolism (CYP1A2); risk of toxicity (hepatotoxicity and accumulation)
Pregnancy & Lactation
Pregnancy: Category C
Limited human data — animal studies show fetal harm. Avoid in pregnancy. Spasticity management in pregnancy: physiotherapy preferred; lowest effective dose of baclofen or tizanidine if necessary.
Lactation: Unknown
No data on breast milk excretion — manufacturer advises avoiding. Assume transfer based on pharmacokinetics; avoid.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Fluvoxamine, ciprofloxacin, oral contraceptives (strong CYP1A2 inhibitors) | CONTRAINDICATED — dramatically increase tizanidine levels (×10 with fluvoxamine) causing severe hypotension and sedation | Major |
| Antihypertensives, alpha-blockers | Additive hypotension — monitor BP closely | Major |
| CNS depressants (benzodiazepines, opioids, alcohol) | Additive CNS depression | Major |
| Rifampicin (CYP1A2 inducer) | Reduces tizanidine levels — reduced efficacy | Moderate |
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Side Effects
Common
- Somnolence (most common — dose-dependent)
- Dry mouth
- Orthostatic hypotension
- Dizziness
- Weakness/fatigue
- Bradycardia
Serious / Discontinue If
- Severe hypotension (especially with CYP1A2 inhibitors — fluvoxamine, ciprofloxacin — CONTRAINDICATED)
- Hepatotoxicity (rare — LFT monitoring)
- Hallucinations and confusion (especially elderly)
- Rebound hypertension (on abrupt withdrawal — similar to clonidine)
Contraindications
- Concurrent fluvoxamine
- Concurrent ciprofloxacin
- Concurrent other strong CYP1A2 inhibitors
- Severe hepatic impairment
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Tizan 2mg | Sun Pharma | 10 tab ₹55 |
| Tizafen 4mg | Cipla | 10 tab ₹85 |
| Tizap 2mg | Torrent | 10 tab ₹48 |
Monitoring Required
- Blood pressure (orthostatic — start and with dose changes)
- LFTs (at 1, 3, 6 months — hepatotoxicity)
- Sedation/functional level
- Spasticity rating (Ashworth scale)
Patient Counseling Points
- Causes significant drowsiness — do not drive or operate machinery; take at bedtime initially
- Rise slowly from bed or chair (low BP on standing)
- ⚠️ NEVER take with ciprofloxacin (an antibiotic) or fluvoxamine (a depression medication) — dangerous interaction causing severe low blood pressure
- Do not stop suddenly after prolonged use — taper gradually to avoid rebound hypertension
- Dry mouth is common — sugar-free gum, adequate water intake helps
- Avoid alcohol — worsens drowsiness significantly
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Clinically reviewed by: Dr. Arun Hegde, MS (Orthopaedics), Consultant Orthopaedic Surgeon
Last reviewed: 2026-04-01
References
- BNF — Tizanidine
- FDA Tizanidine Prescribing Information
- Cochrane — Tizanidine for Spasticity
- European Journal of Neurology — Spasticity Management Guidelines