Common uses
Tizanidine is prescribed to reduce muscle spasticity—the involuntary muscle stiffness and spasms that often follow neurological conditions such as multiple sclerosis (MS), spinal cord injury (SCI), stroke, or certain brain injuries. By dampening signals within the central nervous system, it helps decrease tone and spasms, making movement less painful and improving function in activities like walking, transfers, and self-care.
Clinicians may also consider Tizanidine for select off-label uses when benefits outweigh risks, such as refractory muscle spasms from chronic neck or low-back conditions, or adjunctive therapy in certain headache or myofascial pain syndromes. Evidence for off-label indications varies; any non-labeled use should be guided by a clinician familiar with the patient’s full medical history and concurrent medications.
Because Tizanidine can cause dose-related sedation and drops in blood pressure, its use is typically tailored for times when spasticity is most problematic (for example, before physical therapy sessions, transfers, or sleep), balancing relief with safety and daytime alertness.
Dosage and direction
Typical adult initiation begins with 2 mg taken up to three times daily, spaced 6–8 hours apart. Depending on response and tolerability, the dose can be increased in 2–4 mg increments at each dosing occasion, no more frequently than every few days. Many patients respond within the 8–24 mg/day total range divided into two or three doses. The maximum recommended total is 36 mg per 24 hours, with careful monitoring for adverse effects.
Take Tizanidine consistently with respect to food: the tablet and capsule formulations absorb differently, and food can change the amount absorbed. Choose one approach—always with food or always fasting—and stick to it so the effect is predictable. If switching between tablet and capsule, or changing in relation to meals, consult your prescriber, as dose adjustments may be necessary.
Do not abruptly discontinue after regular or higher-dose use. Sudden cessation can cause rebound hypertension, rapid heartbeat, and worsened spasticity. Your prescriber may advise a gradual taper, reducing the dose stepwise over days to weeks to minimize withdrawal effects.
Special populations: Older adults, those with low blood pressure, and people with liver or kidney impairment often require lower starting doses and slower titration. Always follow the individualized plan provided by your clinician.
Precautions
Tizanidine commonly causes drowsiness, dizziness, and low blood pressure. Until you know how you respond, avoid driving, operating machinery, or activities that require full attention. Standing up slowly can help prevent lightheadedness or fainting, especially at initiation and during dose increases.
Liver safety is a key consideration. Your clinician may check baseline liver function tests (LFTs) and repeat them during dose increases or within the first few months of therapy. Seek medical attention promptly for signs of liver injury, such as dark urine, persistent nausea, abdominal pain, unusual fatigue, or yellowing of the skin or eyes.
Tizanidine can potentiate the effects of alcohol, benzodiazepines, opioids, sedating antihistamines, and other central nervous system depressants. Combining these can increase risks of excessive sedation, falls, and breathing difficulties. It may also augment the blood pressure–lowering effects of antihypertensive medications.
Because Tizanidine is primarily metabolized by the CYP1A2 enzyme, medicines that strongly inhibit or induce this pathway can change its levels substantially. Discuss all prescription drugs, over-the-counter products, hormones (including certain oral contraceptives), supplements, caffeine intake, and tobacco use with your clinician to avoid preventable interactions and side effects.
Contraindications
Do not use Tizanidine if you have a known hypersensitivity to Tizanidine or any formulation component.
Concomitant use with potent CYP1A2 inhibitors is contraindicated: specifically, fluvoxamine and ciprofloxacin. These medications can dramatically increase Tizanidine blood levels, leading to dangerous drops in blood pressure, marked sedation, and other serious effects.
Severe liver disease warrants great caution; many patients with significant hepatic impairment should avoid Tizanidine or use it only with strict monitoring. In all cases, a clinician should assess whether benefits outweigh risks, especially if there is pre-existing low blood pressure, bradycardia, or concurrent therapy that depresses the central nervous system.
Possible side effects
Common side effects include drowsiness, dizziness, dry mouth, fatigue or weakness, low blood pressure, slow heart rate, and gastrointestinal symptoms (nausea, constipation, abdominal discomfort). Some users report blurry vision, nervousness, or insomnia, especially during dose adjustments.
Less common but potentially serious effects include elevated liver enzymes or liver injury (jaundice, dark urine), severe hypotension with fainting, allergic reactions (rash, swelling, difficulty breathing), and hallucinations or mood changes. Abrupt discontinuation after repeated dosing can cause rebound hypertension, increased heart rate, and a surge in spasticity.
Report troublesome or persistent side effects to your clinician. Seek immediate care for signs of severe allergic reaction, severe lightheadedness or fainting, chest pain, or symptoms suggestive of liver problems.
Drug interactions
Strong CYP1A2 inhibitors markedly increase Tizanidine levels and should be avoided: fluvoxamine and ciprofloxacin are the best-known examples. Other CYP1A2 inhibitors, including certain oral contraceptives, some fluoroquinolones, cimetidine, and zileuton, may raise levels and require careful evaluation or avoidance.
CYP1A2 inducers can lower Tizanidine concentrations and reduce effect. Tobacco smoke is a significant inducer; heavy smokers may experience diminished response and should be counseled on consistent use and potential dose needs as advised by a clinician. Changes in smoking status (starting or quitting) may require dose reassessment.
Additive sedation occurs with alcohol, benzodiazepines, opioids, sedating antidepressants, antipsychotics, and antihistamines. Additive hypotension may occur with antihypertensive drugs or other alpha-2 agonists. Combining Tizanidine with other centrally acting muscle relaxants is generally discouraged due to increased risk of side effects without clear added benefit.
Always provide your prescriber and pharmacist with a complete, up-to-date list of medications and supplements to minimize interaction risks.
Missed dose
If you miss a dose, take it as soon as you remember unless it is close to your next scheduled dose. If it is nearly time for the next dose, skip the missed dose and resume your regular schedule. Do not double up to make up for a missed dose; doing so increases the risk of excessive sedation and low blood pressure.
If you regularly forget doses, consider reminders or discussing an adjusted schedule with your clinician to better fit your daily routine.
Overdose
Overdose may cause profound drowsiness, confusion, slurred speech, low blood pressure, slow heart rate, shallow breathing, and loss of consciousness. This is a medical emergency.
If an overdose is suspected, call your local emergency number immediately and contact Poison Control at 1-800-222-1222 in the United States for expert guidance. Do not induce vomiting unless instructed by medical professionals. Supportive care in a medical setting is often required; bringing the medication container to the hospital can help clinicians provide timely, targeted care.
Storage
Store Tizanidine at room temperature (68–77°F or 20–25°C), away from excessive heat, moisture, and direct light. Keep the medication in its original container, tightly closed, and out of reach of children and pets.
Check expiration dates regularly and do not use expired medication. If your prescriber switches you between tablets and capsules, or if you move between different manufacturers, verify details with your pharmacist because absorption can vary among products and with meals.
U.S. Sale and Prescription Policy: why you should not buy Tizanidine without prescription
In the United States, Tizanidine is classified as a prescription-only medication. Federal and state laws require a valid prescription from a licensed clinician after an appropriate evaluation. Purchasing Tizanidine “without prescription” from unverified websites or sellers is unsafe and may be illegal; risks include counterfeit or subpotent products, dangerous contamination, and lack of medical oversight that could lead to serious side effects or interactions.
If you are exploring streamlined ways to access care, telehealth services provide a legitimate path: a licensed healthcare professional reviews your health history, assesses symptoms, and, if appropriate, issues a prescription that can be filled at an accredited pharmacy. Some health systems and rehabilitation networks affiliated with well-known names—including legacy references to Geisinger HealthSouth—offer structured, compliant programs that connect you to clinicians for evaluation and ongoing monitoring. While marketing language may suggest convenience, these programs do not bypass the prescription requirement; rather, they integrate the prescription into the clinical service so you receive Tizanidine only if it is safe and indicated.
To protect your health and comply with regulations, use pharmacies accredited by the National Association of Boards of Pharmacy (NABP) or Verified Internet Pharmacy Practice Sites (VIPPS), and avoid outlets that offer to sell Tizanidine without a prescription. If cost or access is a concern, ask about generics, discount programs, manufacturer assistance, or in-network telemedicine visits that can reduce out-of-pocket expenses while maintaining proper medical oversight.
Bottom line: for safety and legality, do not attempt to buy Tizanidine without prescription. Seek clinician-guided evaluation—in person or via telehealth—to ensure the treatment is appropriate, the dose is individualized, and necessary monitoring (including liver function testing and interaction checks) is in place.
