Did you know that while muscle relaxants can help with spasticity, they also come with risks if not used properly? As many as 84 percent of people in the U.S. with multiple sclerosis (MS) experience muscle spasticity — muscle stiffness or tightness. Muscle relaxants are the most common medication for managing this painful symptom.

Muscle relaxants can help ease spasticity when used along with disease-controlling treatments, physical therapy, and assistive devices. However, they can also interact with other medications or alcohol in dangerous ways. They can worsen other MS symptoms, like fatigue or balance problems.

Some of the most common medications used to manage MS spasticity include:

• Baclofen (Fleqsuvy)
• Dantrolene (Dantrium)
• Diazepam (Valium)
• Tizanidine (Zanaflex)

Read on to learn how muscle relaxants work and how to take them safely.

How Do Muscle Relaxants Work?

Muscle relaxants work in different ways to treat spasticity and muscle spasms. For spasticity, doctors usually prescribe antispastic muscle relaxants as opposed to antispasmodic muscle relaxants. Antispasmodic muscle relaxants treat musculoskeletal pain, muscle tightness, and spasms.

Antispastic muscle relaxants are depressants. These medications slow down activity in your central nervous system (brain and spinal cord) and have a tranquilizing effect. They act directly on your skeletal muscle and spinal cord to reduce tightness in your muscles. Antispastic muscle relaxants also make muscle spasms less severe and happen less often.

Muscle relaxants can come in different forms including capsules, liquids, tablets, or injections. Some people use a baclofen pump, or intrathecal baclofen pump, which continuously delivers the muscle relaxant directly into the fluid in your spinal canal. Healthcare providers give specific instructions on how and when to take prescribed muscle relaxants for MS spasticity.

Tips for Using Muscle Relaxants

The following tips can help you avoid dangerous side effects, complications, and drug interactions while taking muscle relaxants.

Stick to the Prescribed Dosage

Your doctor prescribes muscle relaxants with specific instructions about when and how much to take. You must follow the directions exactly as prescribed to limit side effects and any risk of overdose and addiction.

Keep Track of Your Use

Almost all muscle relaxants cause drowsiness, so it can be easy to forget whether you’ve already taken your scheduled dose. Accidentally doubling up on your dose can put you at risk for side effects and injury. Writing down when you last took your medication, setting an alarm, or using a pill organizer can help you remember your medication and reduce the risk of an accidental overdose.

Steer Clear of Addiction

Some muscle relaxants can be addictive. Taking more than the prescribed amounts puts you at greater risk of overdosing and becoming physically dependent on the medication. Additionally, using them for a long time can increase your tolerance — meaning you need a higher dose to have the same effect. If you have a history of substance abuse, let your doctor know before beginning to take a muscle relaxant prescription.

Don’t Drive on Muscle Relaxants

Muscle relaxants can cause drowsiness, so engaging in certain activities while taking them may be risky to you or others. This includes driving a vehicle or using any type of heavy machinery. Muscle relaxants start working quickly, and their effects typically last four to six hours. Avoid driving while taking a muscle relaxant.

Can you drive on muscle relaxers if you really need to? If you must drive for work or another reason, ask your doctor about adjusting to a lower dose or changing the time when you take your medication to avoid impairment. It’s important to not take this lightly — DUI laws aren’t just limited to alcohol. Driving while impaired because of muscle relaxants is illegal — even if your doctor prescribed the drug.

Don’t Mix Muscle Relaxants With Alcohol or Drugs

Because muscle relaxants cause fatigue and other side effects, mixing them with alcohol or drugs can quickly become unsafe. Alcohol and drugs like opioids and marijuana (cannabis) are depressants, meaning they slow the central nervous system and have a sedating effect. Muscle relaxants are also depressants. When they’re combined, the risk of some side effects is higher and the side effects can be stronger. These include:

• Blurry vision
• Low blood pressure
• Dizziness and fainting
• Drowsiness
• Memory problems
• Liver damage
• Higher risk of overdose

Mixing a muscle relaxant and alcohol or drugs can also be life-threatening, as it can stop your breathing. The bottom line: Never take a muscle relaxant with alcohol, marijuana, opioids, or other drugs.

Know and Avoid Common Medication Interactions

Muscle relaxants can interact with other medications you may be taking. Because muscle relaxants can slow down or calm your body, mixing them with other medications can be dangerous. Various classes of prescription medicine interact with muscle relaxants, including some commonly taken to manage other MS symptoms:

• Anti-seizure medications — For example, cenobamate (Xcopri), gabapentin (Neurontin), and pregabalin (Lyrica)
• Antidepressants — For example, fluoxetine (Prozac) and sertraline (Zoloft)
• Opioids — Pain-relief medications
• Benzodiazepines — Medications that calm the brain and body, often for anxiety or muscle spasms

Always let your doctor know the full list of your prescription medications, so they can make sure it’s safe to add a muscle relaxant to your treatment plan.

Watch for Side Effects

Muscle relaxants have many side effects that may worsen the balance issues linked to MS. Side effects that could put you at risk of injury include:

• Drowsiness
• Dizziness
• Muscle weakness

In serious cases, muscle relaxants can cause blurry vision or fainting. If you’re experiencing any of these side effects, it’s important to tell your doctor.

These side effects can sometimes increase the risk of falls. It’s especially concerning if you take other medications that could make such an injury worse or even life-threatening, such as a blood-thinning medication. Your doctor can adjust your dose or change your medication to minimize or avoid these side effects.

Other Treatments for Spasticity

Muscle relaxants aren’t always the best way to treat muscle spasms. Depending on your symptoms, muscle relaxants might increase your trouble with fatigue or balance. “My doctor is reluctant to give me muscle relaxant medicine, as she’s concerned that with my balance problems, it may cause me to fall and trip,” one MyMSTeam member shared.

Sometimes, an alternative antispasticity treatment option is better than medication, especially because your body can build up a tolerance to the effects of muscle relaxants over time. Exercise, physical therapy, occupational therapy, and electrical stimulation therapy can help with stiff muscles and painful muscle contractions. Botulinum toxin (Botox) injections may also help. Additionally, mobility equipment like standing frames, braces, and splints can provide support. Talk to your doctor about the best treatment plan for your symptoms.

If You Still Have Pain, Talk to Your Doctor

If you have pain from severe spasticity that isn’t going away with your current treatment, it’s understandable to want to double the dose of your muscle relaxant or take it before its scheduled time. This should only be done if your doctor approves.

If your medication isn’t working, ask your doctor for help. Trying another medication or seeing a pain specialist or a physiatrist (a doctor who specializes in physical medicine and rehabilitation) may also help.

Overdosing on muscle relaxants can lead to hallucinations, seizures, heart attack, coma, and even death. If you think you’re experiencing an overdose, or if you’ve taken more pills than what’s been prescribed to you, call 911 or seek emergency care immediately.

Talk With Others Who Understand

MyMSTeam is the social network for people with MS and their loved ones. On MyMSTeam, more than 218,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you tried muscle relaxants or other therapies for spasticity? What has helped you? What precautions do you take to avoid problems? Share your experience in the comments below, or start a conversation by posting on your Activities page.