What is the best muscle relaxer?

Best muscle relaxers | Prescription muscle relaxers | OTC muscle relaxers | Natural muscle relaxers | Side effects | Warnings | Drug interactions

So, you sprained your lower back shooting hoops, a stressful work week spurred on a series of tension headaches, and arthritis has you waking up with stiffness and neck pain. Now what? Tense, aching muscles can be frustrating, distracting, and throw a wrench into your schedule. When muscle pain hits, it can have you looking for fast-acting relief so you can get on with life. Whether you experience back pain, muscle spasms, arthritis, injury-related chronic pain, or even TMJ, muscle relaxers offer fast pain relief, allowing your body to function as usual. Consider this guide your roadmap to the best muscle relaxers on the market. 

What is the best muscle relaxer?

It’s difficult to declare one muscle relaxant better than all others because each type has its own advantages and uses. In general, pain relief treatments fall into one of three categories: over-the-counter (OTC), prescription, and natural. Determining the best muscle relaxer depends entirely on your specific condition and pain level. When in doubt, consult your healthcare provider.

Back and neck pain can be caused by muscles that are spasming. Mild pain can often be treated with over-the-counter (OTC) medicines like nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin (ibuprofen)—or stronger NSAIDs that are available by prescription such as Mobic (meloxicam) or Celebrex (celecoxib). However, although these medicines may help general pain and inflammation, pain related to muscle spasms may not respond to these medications. In these cases, a muscle relaxer may be prescribed, to help with the spasming, tense muscles. Muscle relaxers—often prescribed along with an NSAID—can help reduce spasms, relieve pain, and improve mobility. 

Related: Is Tylenol an NSAID or analgesic?

Prescription drugs: For more chronic pain and conditions where OTC medications just won’t cut it, your doctor may prescribe something stronger. Because of their more serious side effects, prescription muscle relaxers are designed for short-term use, after which your doctor will transition to other drugs or treatments.

Over-the-counter remedies: OTC pain relievers are often the first line of defense against pain, inflammation, and tension. They can work wonders for milder conditions like neck and lower back pain. Typically, your doctor might start you out on an OTC medication, and if that doesn’t provide the relief you need, he or she may write a prescription for something higher-grade.

Natural remedies: For minor soreness and stress-related symptoms, the only treatment you need might be drawn straight from nature. Before rushing off to the doctor for an examination and potential prescription, you might be able to administer an effective plant-based therapy right from home. 

What are the best prescription muscle relaxers?

There are certain times when over-the-counter medications simply aren’t enough. If you’ve been taking acetaminophen or ibuprofen consistently but still dealing with back pain, spasms, or other issues, it might be time for something more robust. In cases like these, doctors may look to prescription muscle relaxants as a more effective, albeit temporary, answer. 

When approached about more serious conditions or injuries, Dr. Lewis doesn’t often recommend OTC remedies. “A pulled back muscle or neck pain may require a doctor’s visit or other diagnostic tests to get to the heart of the issue,” she said. “There are several good prescription medications like methocarbamol, cyclobenzaprine, and metaxalone.”

Recent studies have shown that a type of skeletal muscle relaxants (SMRs), called antispasmodics, outperform anti-inflammatory drugs (NSAIDs), like ibuprofen and acetaminophen, in relieving severe pain associated with conditions like acute back pain. On the flip side, they also have potentially more serious side effects and shouldn’t be used for long-term pain management. Even so, these prescription drugs are effective and reliable options for short-term pain relief.

There are several categories of muscle relaxants.

Antispasmodics

Antispasmodic muscle relaxers may be prescribed for acute, painful musculoskeletal pain/injury. For example, when you “throw out” your back and have limited mobility and severe spasming, an antispasmodic may be prescribed. 

1. Flexeril or Amrix (cyclobenzaprine): Cyclobenzaprine is a popular and relatively inexpensive generic muscle relaxant often used short-term to treat muscle spasms and pain related to sprains, strains, etc. A typical dose is five to 10 mg at bedtime for two to three weeks, although your doctor might approve up to 30 mg daily (taken as one 5 or 10 mg tablet every eight hours) if your case is more severe. Common side effects include drowsiness, dry mouth, dizziness, and fatigue. 
2. Robaxin (methocarbamol): Commonly used to treat severe muscle spasms, back pain, and occasionally tetanus spasms, Robaxin (methocarbamol) is administered orally in up to 1500 mg doses or intravenously in doses of 1000 mg. This dosing is usually higher in the first 48-72 hours, then decreased. Patients may experience drowsiness, dizziness, blurred vision and—in intravenous doses—reactions at the injection site. However, it’s generally less of a sedative than most other muscle relaxants.
3. Skelaxin (metaxalone): While it’s slightly more expensive than other SMRs, like methocarbamol, the upside of Skelaxin is that it delivers the same effectiveness with a relatively low rate of side effects. In three to four 800 mg doses per day, it acts on your central nervous system (brain and spinal cord) and may cause drowsiness, dizziness, irritability, and nausea, but metaxalone doesn’t sedate as heavily as the alternatives.
4. Soma (carisoprodol): Similar to Robaxin, Soma is generally used to treat pain associated with acute musculoskeletal conditions. Carisoprodol acts on the central nervous system to intercept neurotransmitters relayed between the nerves and brain. It’s administered in 250-350 mg doses three times per day (and at bedtime) for up to three weeks. Common side effects include drowsiness, dizziness, and headaches. It has also been associated with addiction, so it should be used with caution.
5. Lorzone (chlorzoxazone): This is yet another SMR that acts on the central nervous system to treat the pain and spasms associated with muscle and bone conditions. It’s fairly well-tolerated despite occasional drowsiness, dizziness, lightheadedness, and malaise. In rare cases, it can cause gastrointestinal bleeding, so doctors will often opt for other medications. Typical dosage is 250 to 750 mg three or four times daily.
6. Norflex (orphenadrine): In addition to treating injury-related pain and spasms, orphenadrine is also effective in relieving the trembling from Parkinson’s disease. Some patients may experience dry mouth along with heart palpitations, blurred vision, weakness, nausea, headache, dizziness, constipation, and drowsiness, but usually only with increased dosages. Standard dosing is 100 mg, twice per day.

Antispastics

Muscle relaxers that are antispastics generally do not treat acute muscle pain. They are more often prescribed for muscle pain due to a medical condition, such as cerebral palsy, multiple sclerosis, or spinal cord injury. 

1. Lioresal (baclofen): Unlike the muscle relaxants above it on this list, baclofen is primarily used to treat spasticity (continuous muscle tightness or stiffness) caused by multiple sclerosis or spinal cord injury. It is given as an oral tablet or can be injected into the spinal canal (intrathecal injection). Most often, baclofen is prescribed on a schedule that increases the dosage gradually every three days. It can cause sleepiness, dizziness, nausea, hypotension (low blood pressure), and headache. 
2. Dantrium (dantrolene): Similar to baclofen, dantrolene is primarily used to treat spasticity. It’s effective for spasms associated with spinal cord injury, stroke, cerebral palsy, or multiple sclerosis, and is also sometimes used for malignant hyperthermia. Common side effects include diarrhea, drowsiness, dizziness, fatigue, and muscle weakness. The starting dosage is 25 mg daily, and it can be increased slowly if needed, up to 100 mg three times daily. In rare cases of overuse or long-term use, it has been attributed to liver disease or damage. The prescribing information recommends that patients who take this drug should receive the lowest effective dosage.
3. Zanaflex (tizanidine): Zanaflex (tizanidine) is primarily used to treat stiffness and spasms associated with multiple sclerosis and cerebral palsy, similar to baclofen. Both show effectiveness, although tizanidine sometimes shows fewer side effects, which can include dry mouth, tiredness, weakness, and dizziness. It’s administered in 2 or 4 mg doses.

Benzodiazepines

Valium (diazepam): Most often, you’ll hear about Valium as a treatment for anxiety disorders and alcohol withdrawal symptoms, but it can also be an effective medication for muscle spasms. Diazepam is a benzodiazepine (like Xanax) that decreases the sensitivity of certain brain receptors. Dosage varies depending on the condition, but for skeletal muscle spasms, it’s typically 2-10 mg, three or four times per day. Because it slows down brain activity, Valium frequently causes fatigue and muscle weakness so, like other muscle relaxants, you shouldn’t combine it with alcohol or certain other drugs. 

Off-Label Drugs

Off-label prescribing is when a drug is prescribed for an indication that is not approved by the Food and Drug Administration (FDA). 

1. Neurontin (gabapentin) is a medication that was originally approved to treat seizures and post-herpetic nerve pain. It is also used off-label to treat nerve pain. 
2. Although Valium is approved to treat muscle spasms, other benzodiazepines such as Klonopin (clonazepam) or Xanax (alprazolam) are not indicated to treat muscle spasms. In some cases, healthcare providers may prescribe a benzodiazepine off-label for muscle pain.
3. Botox (botulinum toxin) is sometimes used for spasticity, alone or in combination with other medications.

What is the best over-the-counter (OTC) medicine for muscle pain?

Neck pain may feel sharp and sudden, and it may be hard to move your neck around. Back pain, depending on the cause, can feel like a dull, achy pain, or a sharp, shooting pain. Back pain can greatly affect mobility, making it difficult to get around. Back pain often extends into the legs or even arms, causing muscle weakness. 

The medicines listed below are the medications that you can find while perusing the aisles at your local pharmacy or convenience store. Most of them are household names, and it’s not uncommon to keep them on hand, stashed in a medicine cabinet, just in case. Even though OTC medications are easy to obtain, they’ll do the job for many aches and pains, and doctors often recommend them prior to prescribing stronger treatment options. 

According to Dr. Joanna Lewis, PharmD, MBA, “OTC NSAIDs, like ibuprofen and naproxen, are a good first-line agent to decrease inflammation surrounding an injury.” They might not have the same potency as high-grade muscle relaxants, but they’re still effective and have very few side effects. If you roll your ankle at the gym or wake up with back pain, try one of these before asking your doctor for a prescription. Note: You should avoid alcohol while taking any of the medications on the list below. Also, NSAIDs should be taken with food to reduce stomach side effects. 

1. Advil (ibuprofen): This is a staple of parents, doctors, and athletes alike. Ibuprofen is one of the most widely-used nonsteroidal anti-inflammatory drugs (NSAIDs) available. As such, Advil doesn’t just remedy pain, but inflammation as well. It’s highly versatile. Use it to treat low back pain, osteoarthritis, menstrual cramps, fever, headaches, migraines, sprains, and other minor injuries. Low doses are available over the counter, but a doctor can prescribe higher doses as well. 
2. Motrin IB (ibuprofen): Don’t be fooled by the different brand name. Motrin IB and Advil are the same drug. Therefore, they shouldn’t be taken together, as it could increase the risk of overdose. 
3. Aleve (naproxen): Another medicine cabinet staple, naproxen is similar to ibuprofen in many ways. It’s also an NSAID, so it works by reducing inflammation. It’s useful in treating muscle pain, headaches, migraines, osteoarthritis, fever, cramps, and minor injuries. The main difference between naproxen and ibuprofen is their dosing. You can take naproxen every eight to 12 hours and ibuprofen every four to six, so Aleve is slightly longer-lasting. 
4. Aspirin: One more OTC NSAID for you. Aspirin treats many of the same conditions, relieving pain and reducing inflammation. However, daily doses of aspirin have been proven effective at reducing the risk of blood clots, strokes, and heart attacks. Ask your doctor before using aspirin for clot prevention. If you’re a candidate you will likely take a “baby” aspirin, or 81 mg, coated tablet daily. Common brand names include Bayer or Ecotrin.
5. Tylenol (acetaminophen): Unlike NSAIDs, acetaminophen focuses solely on treating pain—not inflammation. It’s used for muscle aches, headaches, migraines, back and neck pain, fevers, etc. However, if swelling and inflammation is the underlying cause of your pain, acetaminophen will not be nearly as effective as NSAIDs like those listed above. Acetaminophen’s wide range of uses and relatively few side effects make it the most popular OTC pain reliever worldwide.

Related: List of NSAIDs

What are the best natural muscle relaxers?

Let’s say your pain is lifestyle-related. Maybe a new workout routine put you through the wringer, or slouching over your laptop has started to take its toll on your back and neck. Minor soreness or aches happen all the time for any number of reasons, and they might not be severe or chronic enough to warrant muscle relaxers or other pain relievers. The good news is that there are plenty of natural remedies and dietary solutions to help mild body pain. Even better is that you can find most of these treatments in food and supplements. 

Dr. Lewis considers certain natural remedies ideal for stress management or to supplement other treatments. “Lavender oil and chamomile are great ingredients for relaxation when taking a bath or getting ready for bed,” she said. “They aren’t usually a first-line treatment, but are great in conjunction with other things to manage tension from stress.”

CBD oil (cannabidiol) has been a popular but widely-debated natural supplement. Extracted from the hemp plant, it doesn’t cause a “high” like some may think, but it can be effective in treating epilepsy, insomnia, anxiety, and general pain, among other ailments. Many swear by it for a broad scope of conditions, but research is currently ongoing as to what else it can do. 

The Food and Drug Administration (FDA) has only approved one CBD prescription drug, Epidiolex, which may be prescribed to treat two rare forms of epilepsy. While Epidiolex is regulated by the FDA as a prescription drug, “many [OTC CBD products] are not regulated, [so] the effectiveness between products is not consistent,” Dr. Lewis said.

Or, you may have heard of arnica gel, made from an herb native to central Europe. It’s commonly used to treat injury-related pain and swelling and arthritis. Like CBD, there isn’t extensive research on it yet, but arnica has shown promise as a natural pain remedy.

Want to go the natural route? These natural muscle relaxants are not FDA-proven treatments but may support or promote certain conditions:

While this list isn’t exhaustive, it presents you with plenty of options, no matter what has you hurting. As always, consult your healthcare provider for professional medical advice before taking a new medication. Even natural treatments can cause serious drug-drug interactions.

Common side effects of muscle relaxers

Although each muscle relaxer has a unique list of side effects, there are some common side effects that most muscle relaxers share. Many side effects are due to the sedative effect of muscle relaxers. Common side effects of muscle relaxers include:

• Blurred vision
• Constipation
• Dizziness
• Drowsiness
• Dry mouth
• Headache
• Indigestion
• Nausea
• Nervousness
• Tiredness
• Weakness

Serious side effects may occur. Before taking a muscle relaxer, discuss potential side effects with your healthcare provider. Always be sure to tell your healthcare provider about all of the medications you take, including prescription and OTC drugs, vitamins, and supplements. While serious side effects vary by drug, any drug can cause a serious allergic reaction. Symptoms may include hives, difficulty breathing, or swelling of the face, lips, tongue, or throat. If these symptoms occur, get emergency medical help right away. 

Warnings

Some common warnings of muscle relaxers include:

• Avoid alcohol while taking a muscle relaxer.
• Do not drive or operate machinery until you know how the medicine affects you. 
• Serotonin syndrome is a life-threatening condition that can occur due to the buildup of serotonin. It can sometimes occur if you take too much of the muscle relaxant or when certain other medications are taken with a muscle relaxant such as antidepressants, narcotic pain medications, anti-anxiety medications, or nausea medications. Symptoms can vary from mild to life-threatening and may include agitation, nausea, vomiting, fever, hallucinations, and a fast heartbeat. If you think you have serotonin syndrome, you should get emergency medical help.

Drug Interactions

Before taking a muscle relaxer, tell your healthcare provider about all of the medicines you take. This includes prescription and over-the-counter medications, vitamins, and supplements. Although each muscle relaxant may have some unique drug interactions, there are some common drug interactions to be aware of. 

1. Alcohol: Alcohol should be avoided when taking a muscle relaxer. Muscle relaxers and alcohol are both sedating, so combined, they can cause excess sedation and impairment. The combination can even cause severe respiratory depression, which can slow breathing or even cause a coma or death. 
2. Other drugs that cause central nervous system (CNS) and respiratory depression: These drugs will have the same effects as alcohol. Examples include antianxiety drugs like Valium (diazepam) or Xanax (alprazolam) and narcotic pain medicines such as OxyContin (oxycodone), Ultram (tramadol), or Vicodin (hydrocodone/acetaminophen). Drugs that cause CNS or respiratory depression should not be combined with muscle relaxers. In some cases, when this combination is necessary to be prescribed, the patient will be monitored very closely, taking each drug at the lowest effective dose and for the shortest time possible. 
3. Drugs that cause serotonin syndrome: Certain drugs, when combined with a muscle relaxer, are more likely to cause serotonin syndrome. Some examples include antidepressants such as Prozac (fluoxetine), Paxil (paroxetine), Cymbalta (duloxetine), or Effexor (venlafaxine); older antidepressants in the MAOI class of drugs; narcotic pain medications; the anti-nausea drug Zofran (ondansetron); the supplement St. John’s Wort, and ADHD medications like Adderall and Vyvanse.