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Is there evidence to suggest there is a withdrawal syndrome from muscle relaxants such as tizanidine?

I have observed a trend where patients who are being tapered off of long-term benzodiazepine (especially in the geriatric population) prescriptions are more frequently receiving prescriptions for muscle-relaxant medications such as tizanidine and then experiencing worsening anxiety, panic, or other "withdrawal symptoms" when the muscle relaxants are stopped. How would you approach experience of worsening anxiety and withdrawal prodromes when stopping muscle relaxants? Is there data to use longer-acting alpha-2 agonists (e.g., ER guanfacine)?
1 Answer
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Psychiatry · McLean Hospital/Harvard Medical School
Answered on

The answer is yes, there is evidence in published literature supporting withdrawal manifestations from sudden discontinuation of alpha-2 agonists including tizanidine (references below), primarily due to catecholamine surge causing a sympathetic overdrive, affecting the patient's physiological state...

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