Last reviewed by Miljan Krcobic on September 5th, 2018.
Can you take Flexeril and Ambien together
What is Flexeril
Flexeril is a Brand name for a medication containing cyclobenzaprine as an active ingredient that is used as a muscle relaxant. It works by blocking nerve impulses responsible for pain sensations that should be sent to the brain.
As a muscle relaxant it is used together with physical therapy and other measures for relaxing muscles and relieving pain and discomfort that can be caused by sprains, strains, and different muscle injuries.
Cyclobenzaprine can relieve local muscle spasm with no interruption of muscle function. Flexeril is available in a form of tablets in dosage strengths of 5 and 10 mg. For most patients, usual and recommended dose of Flexeril is 5 mg three times a day.
The dose may be increased to 10 mg three times a day, depending on individual response. This drug should be used only for short-time period (no more than 2-3 weeks).
Other common products on the market containing cyclobenzaprine are: Amrix, Flexmid, Flexiban, Cyclo/mag and Therabenzaprine.
What is Ambien
Ambien is a Brand name for a sedative (hypnotic) drug containing zolpidem as an active ingredient that is used for the treatment of insomnia and other health conditions where major problem is difficulties with falling or staying asleep.
Ambien can slow the activity of the brain and thus enable to falling asleep. It is available in 5 mg and 10 mg strength tablets for oral use. This drug is indicated for the short-term management of insomnia which is characterized by with sleep initiation difficulties.
The dose that is needed for anticonvulsive and muscle relaxant effects is 10-20 times greater compared to the dose needed to cause sedation. This is why Ambien is not used as anticonvulsant and muscle relaxant.
Recently, in the UK, zolpidem has been cited in different medical reports as waking persistent vegetative state patients, and it can dramatically improve health conditions of patients who have brain injuries.
Other common products on the market containing zolpidem are: Edluar, Intermezzo, Zolpimist Dormizol, Nimadorm and Hypnogen.
How does Flexeril and Ambien work in the body
Cyclobenzaprine is a skeletal muscle relaxant and a depressant of the central nervous system. Cyclobenzaprine has effects on the structure in the brain called locus coeruleus, where increases the release of norepinephrine, through the gamma fibers that innervate and inhibit the motor neurons located in the ventral horn the spinal cord.
Cyclobenzaprine can also reduce muscle tone by binding to the 5-HT2 serotonin receptors, antagonizing them and decreasing the activity of descending serotonergic neurons.
Cyclobenzaprine exhibits anticholinergic activity and reseprine antagonism. Structurally it is similar to antidepressant Amitriptyline.
Zolpidem is a nonbenzodiazepine short-acting hypnotic substance that potentiates effects of GABA (gamma-aminobutyric acid), the strongest inhibitory neurotransmitter in the brain, by binding to benzodiazepine receptors places located on the GABA-alpha receptors with chloride channel macromolecular complex.
In contrast to the benzodiazepines which non-selectively interact with all three subtypes of GABA –alpha receptors, zolpidem predominantly and selectively binds to the GABA – alpha-1 receptor.
Indicated for the short-term therapy of insomnia, zolpidem works very quickly, generally within 15 minutes, and has a short half-life time of approximately 2-3 hours.
Can patients take Flexeril and Ambien together
Patients should not use Flexeril and Ambien together without consulting their doctor first. Combination of these drugs may increase side effects such as: drowsiness, dizziness, confusion, and difficulty concentrating.
Some people, especially the elderly, may experience impairment in judgment, thinking, and motor coordination. If combination of these drugs is taken, patients shouldn’t drive or operate machinery.
The table below shows side effects after Flexeril and Ambien administration in recommendable doses. The incidence can be significantly increased if these drugs are overdosed or taken together.
|Very common side effects >10%||Drowsiness (up to 39%), Dry mouth (21-32%), Dizziness (5-12%), Headache (7-19%),|
|Common side effects 1-10%||Fatigue (6%), Palpitations (6%), Indigestion (4%), Bad taste in mouth (1-6%), Myalgia (4%), Sinusitis (4%), Allergy (4%), Hallucinations (4%), Blurred vision (3%), Memory disorder (3%), Visual disturbance (3%), Constipation (1-3%), Confusion (1-3%), Asthenia (1-3%), Nausea (1-3%), Nervousness (1-3%), Pharyngitis (1-3%), Lightheadedness (2%), Constipation (2%), Asthenia (1%)|
|Rare side effects <1%||Arrhythmias, Palpitation, Tachycardia, Hypotension, Hepatitis, Jaundice, Vasodilation, Syncope, Immune hypersensitivity reaction, Anaphylaxis, Cardiac dysrhythmia, Cholestasis|
|Postmarketing reports||Respiratory depression, Oral ulcers, blisters, and mucosal inflammation|
Special precautions and warnings during Flexeril and Ambien administration:
- Patients should tell their doctor and pharmacist if they are allergic to Flexeril or Ambien or any other medicines, or any of the inactive ingredients in Ambien or Flexeril products.
- Patients should also tell their doctor and pharmacist what prescription and nonprescription medicines, nutritional supplements, herbal products or vitamins, they are taking or plan to take. It is important to mention if they are using any of the following medicines: antidepressants including imipramine and sertraline, chlorpromazine, itraconazole, ketoconazole, rifampin, drugs for anxiety, colds or allergies, pain, mental illness or seizures, or other sedatives, sleeping pills and tranquilizers. Doctor may need to change the doses of medicines or monitor carefully for side effects.
- Patients should avoid alcohol while using these medications. Drinking alcohol can increase certain side effects of these medications. Alcohol may add the side effects that can be caused by taking Flexeril and Ambien.
- Patients using Flexeril should tell their doctor and pharmacist what nonprescription or prescription drugs they are taking or have taken within the last 2 weeks, especially drugs for seizures, depression, allergies, coughs, or colds, MAO inhibitors (phenelzine, tranylcypromine), sleeping pills, tranquilizers, sedatives and vitamins.
- Patients should also tell their doctor if they are using Flexeril and have an overactive thyroid gland, glaucoma, heart disease or difficulties with urinating.
- Patients should tell their doctor if they are pregnant or plan to become pregnant, or are breast-feeding. Flexeril and Ambien should not be used during pregnancy and breastfeeding.
- Patients who are 65 years of age or older should talk to their doctor about the risks and benefits of taking Flexeril, because it is not as effective and safe as other medications indicated for the treatment of the same conditions.
- In most cases Flexeril and Ambien can make patients drowsy. They should not drive a car or operate machinery during Flexeril or Ambien administration.
- Patients should not take more than one dose on the same night. If they have taken Ambien or some other sleeping pill, and if they wake up in the middle of the night, they shouldn’t take a sublingual form of zolpidem such as Intermezzo or any other sleeping pill.
- Patients should know that there were cases of somnambulism (sleep-walking) in patients who were on zolpidem therapy. Such patients have: prepared and ate food, got out of bed and drove their cars, had sex, made phone calls, or were involved in other activities while not fully awake. After they woke up, these people were usually unable to remember what they had done. Patients should call their doctor immediately if they find out that something similar happened to them.
- Patients have to know that their mental health and behavior can change in unpredicted ways while they are taking Ambien.
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