Tizanidine

Changes in pharmacokinetics of tizanidine when administered with ciprofloxacin resulted in significantly decreased blood pressure, increased drowsiness, and increased psychomotor impairment [See Contraindications (4) and Clinical Pharmacology ( 12.3 ) ] 7.3 CYP1A2 Inhibitors other than Fluvoxamine and Ciprofloxacin Because of potential drug interactions, concomitant use of tizanidine hydrochloride with other CYP1A2 inhibitors, such as zileuton, fluoroquinolones other than strong CYP1A2 inhibitors (which are contraindicated), antiarrythmics (amiodarone, mexiletine, propafenone, and verapamil), cimetidine, famotidine, oral contraceptives, acyclovir, and ticlopidine) should be avoided.

[see Contraindications (4) and Clinical Pharmacology ( 12.3 ) ] 7.2 Ciprofloxacin Concomitant use of ciprofoxacin and tizanidine hydrochloride is contraindicated. Changes in pharmacokinetics of tizanidine when administered with ciprofloxacin resulted in significantly decreased blood pressure, increased drowsiness, and increased psychomotor impairment [See Contraindications (4) and Clinical Pharmacology ( 12.3 ) ] 7.3 CYP1A2 Inhibitors other than Fluvoxamine and Ciprofloxacin Because of potential drug interactions, concomitant use of tizanidine hydrochloride with other CYP1A2 inhibitors, such as zileuton, fluoroquinolones other than strong CYP1A2 inhibitors (which are contraindicated), antiarrythmics (amiodarone, mexiletine, propafenone, and verapamil), cimetidine, famotidine, oral contraceptives, acyclovir, and ticlopidine) should be avoided.

Concomitant administration is contraindicated due to potentiation of hypotensive and sedative effects of tizanidine.

Concomitant administration is contraindicated due to potentiation of hypotensive and sedative effects of tizanidine.

Famotidine is a weak CYP1A2 inhibitor and may substantially increase tizanidine blood concentrations, resulting in hypotension, bradycardia, or excessive drowsiness. Avoid concomitant use if possible.

Concomitant use is contraindicated. Results in significantly decreased blood pressure, increased drowsiness, and increased psychomotor impairment.

Increases drug levels in bloodstream and increases adverse reactions. CNS depressant effects are additive.

CYP1A2 inhibitor antiarrhythmic; concomitant use should be avoided due to potential for hypotension, bradycardia, or excessive drowsiness.

CYP1A2 inhibitor; concomitant use should be avoided due to potential for hypotension, bradycardia, or excessive drowsiness.

Avoid concomitant use as deferasirox inhibits CYP1A2 and tizanidine has a narrow therapeutic index.

CYP1A2 inhibitor antiarrhythmic; concomitant use should be avoided due to potential for hypotension, bradycardia, or excessive drowsiness.

Concomitant use is not recommended. If clinically necessary, initiate tizanidine with 2 mg dose and titrate in 2-4 mg steps daily.

CYP1A2 inhibitor antiarrhythmic; concomitant use should be avoided due to potential for hypotension, bradycardia, or excessive drowsiness.

CYP1A2 inhibitor; concomitant use should be avoided due to potential for hypotension, bradycardia, or excessive drowsiness.

CYP1A2 substrate with narrow therapeutic window. Vemurafenib increased tizanidine systemic exposure by 4.7-fold. Avoid concomitant use or monitor closely for toxicities and consider dose reduction.

CYP1A2 inhibitor; concomitant use should be avoided due to potential for hypotension, bradycardia, or excessive drowsiness.

CYP1A2 inhibitor; concomitant use should be avoided due to potential for hypotension, bradycardia, or excessive drowsiness.

Increases in exposure may be observed as cannabidiol is a weak CYP1A2 inhibitor. Consider dosage reduction where minimal concentration changes may lead to serious adverse reactions.

Concomitant use not recommended; hypotensive effects may be cumulative.

Fexinidazole inhibits CYP1A2, increasing tizanidine concentrations and risk of adverse reactions.

Potential interaction due to fluvoxamine inhibition of CYP1A2, which is involved in tizanidine metabolism.

Exposure to tizanidine may be reduced when coadministered with leflunomide. Monitor and adjust dose as required.

Exposure of tizanidine may be reduced in patients taking leflunomide. Monitor and adjust dose as required.

COCs containing ethinyl estradiol may inhibit the metabolism of tizanidine.

CNS depressants with potentially additive sedative effects. Monitor for excess sedation.

CHCs may inhibit metabolism and increase plasma concentrations of tizanidine.

COCs containing ethinyl estradiol may inhibit metabolism and increase plasma concentrations.

Ethinyl estradiol may inhibit tizanidine metabolism and increase its plasma concentration.

COCs containing ethinyl estradiol may inhibit metabolism of tizanidine, potentially increasing its plasma concentrations.

Ethinyl estradiol may inhibit the metabolism of tizanidine and increase its plasma concentrations.

CYP1A2 substrate with narrow therapeutic index. Use with caution as osilodrostat may affect tizanidine metabolism.

Primaquine may inhibit CYP1A2 and increase tizanidine exposure; increased monitoring for adverse reactions is recommended.

Teriflunomide may reduce exposure of tizanidine. Monitor patients and adjust dose as required.