Tizanidine has 33 known drug interactions based on U.S. FDA drug labeling data. Of these, 6 are contraindicated combinations that should be avoided entirely. 11 are classified as major interactions requiring close medical supervision. Notable interactions include combinations with Acyclovir, Ciprofloxacin, Ciprofloxacin Hydrochloride. Patients taking Tizanidine should inform their healthcare provider of all current medications — including over-the-counter drugs and supplements — to avoid potentially harmful combinations. Data sourced from OpenFDA and the NIH National Library of Medicine.
- Total
- 33
- Contraindicated
- 6
- Major
- 11
- Moderate
- 16
Contraindicated (6)
- Tizanidine + Acyclovir— Changes in pharmacokinetics of tizanidine when administered with ciprofloxacin resulted in significantly decreased blood…
- Tizanidine + Ciprofloxacin— [see Contraindications (4) and Clinical Pharmacology ( 12.3 ) ] 7.2 Ciprofloxacin Concomitant use of ciprofoxacin and ti…
- Tizanidine + Ciprofloxacin Hydrochloride— Concomitant administration is contraindicated due to potentiation of hypotensive and sedative effects of tizanidine.
- Tizanidine + Ciprofloxacin Tablets— Concomitant administration is contraindicated due to potentiation of hypotensive and sedative effects of tizanidine.
- Tizanidine + Famotidine— Famotidine is a weak CYP1A2 inhibitor and may substantially increase tizanidine blood concentrations, resulting in hypot…
- Tizanidine + Fluvoxamine— Concomitant use is contraindicated. Results in significantly decreased blood pressure, increased drowsiness, and increas…
Major (11)
- Tizanidine + Alcohol— Increases drug levels in bloodstream and increases adverse reactions. CNS depressant effects are additive.
- Tizanidine + Amiodarone— CYP1A2 inhibitor antiarrhythmic; concomitant use should be avoided due to potential for hypotension, bradycardia, or exc…
- Tizanidine + Cimetidine— CYP1A2 inhibitor; concomitant use should be avoided due to potential for hypotension, bradycardia, or excessive drowsine…
- Tizanidine + Deferasirox— Avoid concomitant use as deferasirox inhibits CYP1A2 and tizanidine has a narrow therapeutic index.
- Tizanidine + Mexiletine— CYP1A2 inhibitor antiarrhythmic; concomitant use should be avoided due to potential for hypotension, bradycardia, or exc…
- Tizanidine + Oral Contraceptives— Concomitant use is not recommended. If clinically necessary, initiate tizanidine with 2 mg dose and titrate in 2-4 mg st…
- Tizanidine + Propafenone— CYP1A2 inhibitor antiarrhythmic; concomitant use should be avoided due to potential for hypotension, bradycardia, or exc…
- Tizanidine + Ticlopidine— CYP1A2 inhibitor; concomitant use should be avoided due to potential for hypotension, bradycardia, or excessive drowsine…
- Tizanidine + Vemurafenib— CYP1A2 substrate with narrow therapeutic window. Vemurafenib increased tizanidine systemic exposure by 4.7-fold. Avoid c…
- Tizanidine + Verapamil— CYP1A2 inhibitor; concomitant use should be avoided due to potential for hypotension, bradycardia, or excessive drowsine…
- Tizanidine + Zileuton— CYP1A2 inhibitor; concomitant use should be avoided due to potential for hypotension, bradycardia, or excessive drowsine…
Moderate (16)
- Tizanidine + Cannabidiol— Increases in exposure may be observed as cannabidiol is a weak CYP1A2 inhibitor. Consider dosage reduction where minimal…
- Tizanidine + Estrogens— Concomitant use not recommended; hypotensive effects may be cumulative.
- Tizanidine + Fexinidazole— Fexinidazole inhibits CYP1A2, increasing tizanidine concentrations and risk of adverse reactions.
- Tizanidine + Fluvoxamine Maleate— Potential interaction due to fluvoxamine inhibition of CYP1A2, which is involved in tizanidine metabolism.
- Tizanidine + Leflunomide— Exposure to tizanidine may be reduced when coadministered with leflunomide. Monitor and adjust dose as required.
- Tizanidine + Leflunomide And Diclofenac Sodium Gel— Exposure of tizanidine may be reduced in patients taking leflunomide. Monitor and adjust dose as required.
- Tizanidine + Levonorgestrel And Ethinyl Estradiol And Ferrous Fumarate— COCs containing ethinyl estradiol may inhibit the metabolism of tizanidine.
- Tizanidine + Nitrazepam— CNS depressants with potentially additive sedative effects. Monitor for excess sedation.
- Tizanidine + Norelgestromin And Ethinyl Estradiol— CHCs may inhibit metabolism and increase plasma concentrations of tizanidine.
- Tizanidine + Norethindrone Acetate, Ethinyl Estradiol And Ferrous Fumarate— COCs containing ethinyl estradiol may inhibit metabolism and increase plasma concentrations.
- Tizanidine + Norethindrone Acetate/Ethinyl Estradiol— Ethinyl estradiol may inhibit tizanidine metabolism and increase its plasma concentration.
- Tizanidine + Norethindrone And Ethinyl Estradiol— COCs containing ethinyl estradiol may inhibit metabolism of tizanidine, potentially increasing its plasma concentrations…
- Tizanidine + Norgestimate And Ethinyl Estradiol— Ethinyl estradiol may inhibit the metabolism of tizanidine and increase its plasma concentrations.
- Tizanidine + Osilodrostat— CYP1A2 substrate with narrow therapeutic index. Use with caution as osilodrostat may affect tizanidine metabolism.
- Tizanidine + Primaquine Phosphate— Primaquine may inhibit CYP1A2 and increase tizanidine exposure; increased monitoring for adverse reactions is recommende…
- Tizanidine + Teriflunomide— Teriflunomide may reduce exposure of tizanidine. Monitor patients and adjust dose as required.