carisoprodol

Absorption: Well absorbed after oral administration.

Distribution: Crosses the placenta; high concentrations in breast milk.

Metabolism/Excretion: Mostly metabolized by the liver via the CYP2C19 isoenzyme to meprobamate; the CYP2C19 enzyme system exhibits genetic polymorphism (2% of Whites, 4% of Blacks, and 14% of Asians may be poor metabolizers and may have significantly ↑ carisoprodol concentrations and an ↑ risk of adverse effects). Excreted by both renal and non-renal pathways. .

Half-Life: Carisoprodol: 2 hr; meprobamate: 10 hr.

Time/Action Profile ⬆ ⬇

(skeletal muscle relaxation)

ROUTE	ONSET	PEAK	DURATION
PO	30 min	unknown	4–6 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to carisoprodol or to meprobamate;
Porphyria.

Use Cautiously in:

Severe renal impairment;
Severe hepatic impairment;
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Children <16 yr (safety and effectiveness not established);
Geri: Appears on Beers list. ↑ risk of anticholinergic adverse reactions, sedation, and fractures in older adults. Avoid use in older adults..

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, tachycardia

Derm: flushing, rash

GI: epigastric distress, hiccups, nausea, vomiting

Hemat: eosinophilia, leukopenia

Neuro: dizziness, drowsiness, agitation, ataxia, depression, headache, insomnia, irritability, syncope

Resp: asthma attacks

Misc: ANAPHYLACTIC SHOCK, fever, psychological dependence

Interactions ⬆ ⬇

Drug-drug:

Additive CNS depression with other CNS depressants including alcohol, antihistamines, opioid analgesics, and sedative/hypnotics.

Drug-Natural Products:

Concomitant use of kava-kava, valerian, skullcap, chamomile, or hops can ↑ CNS depression.

Route/Dosage ⬆ ⬇

PO (Adults ≥16 yr): 250–350 mg 4 times daily for no longer than 2–3 wk.

Availability ⬆ ⬇

(Generic available)

Tablets: 250 mg; 350 mg

Assessment ⬆ ⬇

Assess patient for pain, muscle stiffness, and range of motion before and periodically during therapy.
Observe for idiosyncratic symptoms (extreme weakness, quadriplegia, dizziness, ataxia, dysarthria, visual disturbances, agitation, euphoria, confusion, disorientation); may appear within minutes or hours of first dose. Usually subsides over several hours.
Geri: Assess geriatric patients for anticholinergic effects (sedation and weakness).
Assess risk for addiction, abuse, or misuse prior to administration and periodically during therapy.

Implementation ⬆ ⬇

Should be used ONLY for acute treatment periods of no more than 2–3 wk.
Provide safety measures as indicated. Supervise ambulation and transfer of patients.
PO: Administer with food to minimize GI irritation.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed. Missed doses should be taken within 1 hr; if not, omit and return to regular dosing schedule. Do not double doses. Advise patient taking large doses of carisoprodol or for a prolonged time to gradually decrease dose. Abrupt discontinuation may lead to withdrawal symptoms (insomnia, vomiting, abdominal cramps, headache, tremors, muscle twitching, anxiety, ataxia, hallucinations, psychosis).
Inform patient that use is limited to acute relief of musculoskeletal discomfort of 2–3 wk. Prolonged use may lead to dependence, withdrawal, and abuse. Encourage patient to comply with additional therapies prescribed for muscle spasm (rest, physical therapy, heat, etc). If musculoskeletal discomfort persists consult health care professional for further evaluation.
May cause dizziness or drowsiness. Advise patient to avoid driving or other activities requiring alertness until response to drug is known.
Advise patient that carisoprodol is a drug with known abuse potential. Protect it from theft, and never give to anyone other than the individual for whom it was prescribed. Store out of sight and reach of children, and in a location not accessible by others.
Instruct patient to change positions slowly to minimize orthostatic hypotension.
Advise patient to avoid concurrent use of alcohol and other CNS depressants (benzodiazepines, opioids, tricyclic antidepressants, sedating antihistamines, sedatives) while taking this medication, may cause overdose.
Instruct patient to notify health care professional if signs of allergy (rash, hives, swelling of tongue or lips, dyspnea) or idiosyncratic reaction occur.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Monitor infants exposed to carisoprodol via breastfeeding for sedation.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆ ⬇

Contr. Subst. Schedule ⬆ ⬇

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