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Methocarbamol: Pediatric drug information

Methocarbamol: Pediatric drug information
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For additional information see "Methocarbamol: Drug information" and "Methocarbamol: Patient drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: US
  • Robaxin;
  • Tanlor
Brand Names: Canada
  • Robaximol [DSC]
Therapeutic Category
  • Skeletal Muscle Relaxant, Nonparalytic
Dosing: Pediatric
Muscle spasm

Muscle spasm: Adolescents ≥16 years: Oral: 1,500 mg 4 times daily for 2 to 3 days; maximum daily dose: 8 g/day (reserved for severe conditions); then decrease dose to 4,000 to 4,500 mg/day in 3 to 6 divided doses (ie, 1,000 mg 4 times daily or 750 mg every 4 hours or 1,500 mg 3 times daily).

Postoperative pain, adjunct

Postoperative pain, adjunct: Very limited data available. Note: Use described in patients following minimally invasive repair of pectus excavatum and spinal fusion surgery as part of a multimodal postoperative pain protocol (Ref).

Children ≥4 years and Adolescents:

Postoperative day (POD) 0:

IV: 10 mg/kg/dose every 6 to 8 hours for 48 to 72 hours. Maximum adult daily dose: 3,000 mg/day for no more than 3 consecutive days (Ref).

POD 2 or 3:

Oral: 10 mg/kg/dose every 6 to 8 hours. Maximum adult daily dose: 4,000 mg/day (Ref).

Tetanus

Tetanus: Note: Use has generally been replaced by other agents (eg, benzodiazepines) (Ref):

Infants, Children, and Adolescents: IV: 15 mg/kg/dose or 500 mg/m2/dose; may repeat every 6 hours as needed; usual adult dose: 1,000 to 2,000 mg/dose; maximum total dose: 1.8 g/m2 for 3 days; in adults, injection is not recommended for use longer than 3 days.

Dosing: Kidney Impairment: Pediatric

Children and Adolescents: There are no dosage adjustments provided in the manufacturer's labeling; however, administration of the parenteral formulation is contraindicated in patients with renal dysfunction due to the presence of polyethylene glycol.

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, elimination may be reduced in patients with cirrhosis.

Dosing: Adult

(For additional information see "Methocarbamol: Drug information")

Muscle spasm

Muscle spasm:

Note: For skeletal muscle spasm and/or pain (eg, low back pain, neck pain) with muscle spasm, usually in combination with a nonsteroidal anti-inflammatory drug and/or acetaminophen (Ref). In general, muscle relaxants should be used temporarily (eg, for a few days or intermittently for a few days when needed) (Ref).

Oral: 1.5 g 3 to 4 times daily for 2 to 3 days (up to 8 g/day may be given in severe conditions), then decrease dose to ≤4.5 g/day in 3 to 4 divided doses (eg, 1.5 g 3 times daily or 750 mg 4 times daily) (Ref).

IM, IV: Initial: 1 g; may repeat every 8 hours; maximum dose: 3 g/day for no more than 3 consecutive days. If condition persists, may repeat course of therapy after a drug-free interval of 48 hours.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

IV: Use contraindicated in patients with kidney impairment due to the presence of polyethylene glycol (Ref).

Oral:

Altered kidney function: Mild to severe impairment: Limited data suggest no dosage adjustment necessary (Ref); use with caution (Ref).

Hemodialysis, intermittent (thrice weekly): Unknown dialyzability: No dosage adjustment necessary (Ref); drowsiness has been described in patients with end-stage kidney disease (ESKD) (Ref); use with caution (Ref).

Peritoneal dialysis: Unknown dialyzability: No dosage adjustment necessary (Ref); drowsiness has been described in patients with ESKD (Ref); use with caution (Ref).

Dosing: Liver Impairment: Adult

No dosage adjustment provided in manufacturer’s labeling. However, elimination may be reduced in patients with cirrhosis.

Adverse Reactions (Significant): Considerations
CNS effects and fall/injury risk

Methocarbamol may cause CNS effects, including (but not limited to) dizziness and drowsiness, which may impair physical or mental abilities (Ref). Confusion and sedated state may also occur (Ref). Methocarbamol has been associated with an increased risk of accidental injury (including falling and bone fracture) in older adults (Ref).

Mechanism: Related to the pharmacologic action (ie, global CNS depression) (Ref).

Risk factors:

• Continuous use within the prior 60 days (increased risk of injuries in older adults) (Ref)

• Concurrent use of alcohol or other CNS depressants

• Older adults (>65 years) (Ref)

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined:

Cardiovascular: Bradycardia, flushing, hypotension, syncope, thrombophlebitis

Dermatologic: Pruritus, skin rash, urticaria

Gastrointestinal: Dyspepsia, nausea, vomiting

Hematologic & oncologic: Leukopenia

Hepatic: Cholestatic jaundice, jaundice

Hypersensitivity: Anaphylaxis, angioedema

Local: Local skin exfoliation (injection), pain at injection site

Nervous system: Amnesia, ataxia, confusion, headache, insomnia, metallic taste, sedated state, seizure, vertigo

Ophthalmic: Blurred vision, conjunctivitis, diplopia, nystagmus disorder

Respiratory: Nasal congestion

Miscellaneous: Fever

Postmarketing:

Nervous system: Dizziness (Ref), drowsiness (Ref), falling (Ref)

Neuromuscular & skeletal: Bone fracture (Ref)

Miscellaneous: Accidental injury (Ref)

Contraindications

Hypersensitivity to methocarbamol or any component of the formulation; renal impairment (injection formulation)

Warnings/Precautions

Disease-related concerns:

• Hepatic impairment: Plasma protein binding and clearance are decreased and the half-life is increased in patients with hepatic impairment.

• Renal impairment: Use of IV formulation is contraindicated.

• Seizure disorder: Use the oral formulation with caution in patients with a history of seizure disorder. Intravenous administration to patients with a seizure disorder is not recommended.

Special populations:

• Pediatric: IV formulation: Recommended only for the treatment of tetanus in pediatric patients.

Dosage form specific issues:

• Injection: Contraindicated in renal impairment. Contains polyethylene glycol. Rate of injection should not exceed 3 mL/minute; solution is hypertonic; avoid extravasation.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Injection:

Robaxin: 1000 mg/10 mL (10 mL) [pyrogen free; contains polyethylene glycol 300 (peg-6)]

Generic: 1000 mg/10 mL (10 mL)

Solution, Injection [preservative free]:

Robaxin: 1000 mg/10 mL (10 mL) [contains polyethylene glycol 300 (peg-6)]

Generic: 1000 mg/10 mL (10 mL)

Tablet, Oral:

Tanlor: 1000 mg [contains fd&c blue #1 (brill blue) aluminum lake]

Generic: 500 mg, 750 mg, 1000 mg

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Methocarbamol Injection)

1000 mg/10 mL (per mL): $0.75 - $2.06

Solution (Robaxin Injection)

1000 mg/10 mL (per mL): $0.96

Tablets (Methocarbamol Oral)

500 mg (per each): $0.04 - $15.73

750 mg (per each): $0.05 - $0.73

1000 mg (per each): $36.00

Tablets (Tanlor Oral)

1000 mg (per each): $28.20

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Injection:

Robaximol: 100 mg/mL ([DSC])

Administration: Pediatric

Oral: Tablet: May be crushed and mixed with food or liquid if needed.

Parenteral: IV: May be directly injected undiluted at a maximum rate of 3 mL/minute; may also be further diluted and infused more slowly; patient should be in the recumbent position during and for 10 to 15 minutes after IV administration. Monitor closely for extravasation.

Administration: Adult

Solution for injection:

IM: A maximum of 5 mL can be administered into each gluteal region.

IV: Maximum rate: 3 mL/minute; may be administered undiluted or diluted. Monitor closely for extravasation. Administer IV while in recumbent position. Maintain position for at least 10-15 minutes following infusion.

Tablet: May be crushed and mixed with food or liquid if needed.

Storage/Stability

Solution for injection: Prior to dilution, store at controlled room temperature of 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).

Tablet: Store at controlled room temperature of 20°C to 25°C (68°F to 77°F).

Use

Adjunctive treatment of muscle spasm associated with acute painful musculoskeletal conditions (Oral: FDA approved in ages ≥16 years and adults; injection: FDA approved in adults); adjunctive treatment of muscle spasm associated with tetanus (Injection: FDA approved in pediatric patients [age not specified] and adults); has also been used as adjunct treatment of postoperative pain.

Medication Safety Issues
Sound-alike/look-alike issues:

Methocarbamol may be confused with mephobarbital

Robaxin may be confused with ribavirin, Skelaxin

Older Adult: High-Risk Medication:

Beers Criteria: Methocarbamol is identified in the Beers Criteria as a potentially inappropriate medication to be avoided in patients 65 years and older (independent of diagnosis or condition) because most muscle relaxants are poorly tolerated in older adults due to anticholinergic effects caused by some muscle relaxants, risk of sedation, and an increased risk of fracture. In addition, efficacy is questionable at doses tolerated by geriatric patients (Beers Criteria [AGS 2023]).

International issues:

Robaxin [US, Canada, Great Britain, Greece, Spain] may be confused with Rubex brand name for ascorbic acid [Ireland]; doxorubicin [Brazil]

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program

Acrivastine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Alcohol (Ethyl): CNS Depressants may increase CNS depressant effects of Alcohol (Ethyl). Risk C: Monitor

Alizapride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Amisulpride (Oral): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Articaine: May increase CNS depressant effects of CNS Depressants. Management: Consider reducing the dose of articaine if possible when used in patients who are also receiving CNS depressants. Monitor for excessive CNS depressant effects with any combined use. Risk D: Consider Therapy Modification

Azelastine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Benperidol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Blonanserin: CNS Depressants may increase CNS depressant effects of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider Therapy Modification

Botulinum Toxin-Containing Products: Muscle Relaxants (Centrally Acting) may increase adverse/toxic effects of Botulinum Toxin-Containing Products. Specifically, the risk for increased muscle weakness may be enhanced. Risk C: Monitor

Brexanolone: CNS Depressants may increase CNS depressant effects of Brexanolone. Risk C: Monitor

Brimonidine (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Bromopride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Bromperidol: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Buclizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Buprenorphine: CNS Depressants may increase CNS depressant effects of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider Therapy Modification

BusPIRone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Cannabinoid-Containing Products: CNS Depressants may increase CNS depressant effects of Cannabinoid-Containing Products. Risk C: Monitor

Cetirizine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk D: Consider Therapy Modification

Chloral Hydrate/Chloral Betaine: CNS Depressants may increase CNS depressant effects of Chloral Hydrate/Chloral Betaine. Management: Consider alternatives to the use of chloral hydrate or chloral betaine and additional CNS depressants. If combined, consider a dose reduction of either agent and monitor closely for enhanced CNS depressive effects. Risk D: Consider Therapy Modification

Chlormethiazole: May increase CNS depressant effects of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Risk D: Consider Therapy Modification

Chlorphenesin Carbamate: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

CNS Depressants: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Dantrolene: May increase adverse neuromuscular effects of Muscle Relaxants (Centrally Acting). Specifically, neuromuscular block may be potentiated. Risk C: Monitor

Daridorexant: May increase CNS depressant effects of CNS Depressants. Management: Dose reduction of daridorexant and/or any other CNS depressant may be necessary. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification

DexmedeTOMIDine: CNS Depressants may increase CNS depressant effects of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider Therapy Modification

Difelikefalin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Difenoxin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Dihydralazine: CNS Depressants may increase hypotensive effects of Dihydralazine. Risk C: Monitor

Dimethindene (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Dothiepin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Doxylamine: CNS Depressants may increase CNS depressant effects of Doxylamine. Risk C: Monitor

DroPERidol: May increase CNS depressant effects of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider Therapy Modification

Emedastine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk C: Monitor

Entacapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Eperisone: May increase adverse/toxic effects of Methocarbamol. Specifically the risk for visual disturbances and enhanced CNS depressant effects may be increased. Risk C: Monitor

Esketamine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Flunarizine: CNS Depressants may increase CNS depressant effects of Flunarizine. Risk X: Avoid

Flunitrazepam: CNS Depressants may increase CNS depressant effects of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Risk D: Consider Therapy Modification

HydrOXYzine: May increase CNS depressant effects of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider Therapy Modification

Ixabepilone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kava Kava: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ketotifen (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kratom: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Lemborexant: May increase CNS depressant effects of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Risk D: Consider Therapy Modification

Levocetirizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lisuride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lofepramine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lofexidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Loxapine: CNS Depressants may increase CNS depressant effects of Loxapine. Management: Consider reducing the dose of CNS depressants administered concomitantly with loxapine due to an increased risk of respiratory depression, sedation, hypotension, and syncope. Risk D: Consider Therapy Modification

Magnesium Sulfate: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Melitracen [INT]: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Mequitazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Metergoline: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Methotrimeprazine: CNS Depressants may increase CNS depressant effects of Methotrimeprazine. Methotrimeprazine may increase CNS depressant effects of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Risk D: Consider Therapy Modification

Methoxyflurane: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Metoclopramide: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

MetyroSINE: CNS Depressants may increase sedative effects of MetyroSINE. Risk C: Monitor

Minocycline (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Moxonidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Nabilone: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Nalfurafine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Noscapine: CNS Depressants may increase adverse/toxic effects of Noscapine. Risk X: Avoid

Olopatadine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Opicapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Opioid Agonists: CNS Depressants may increase CNS depressant effects of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

Opipramol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Orphenadrine: CNS Depressants may increase CNS depressant effects of Orphenadrine. Risk X: Avoid

Oxomemazine: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Oxybate Salt Products: CNS Depressants may increase CNS depressant effects of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interrupt oxybate salt treatment during short-term opioid use Risk D: Consider Therapy Modification

OxyCODONE: CNS Depressants may increase CNS depressant effects of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

Paliperidone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Paraldehyde: CNS Depressants may increase CNS depressant effects of Paraldehyde. Risk X: Avoid

Perampanel: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Periciazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Pipamperone: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Piribedil: CNS Depressants may increase CNS depressant effects of Piribedil. Risk C: Monitor

Pizotifen: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Pramipexole: CNS Depressants may increase sedative effects of Pramipexole. Risk C: Monitor

Procarbazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Rilmenidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ropeginterferon Alfa-2b: CNS Depressants may increase adverse/toxic effects of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider Therapy Modification

ROPINIRole: CNS Depressants may increase sedative effects of ROPINIRole. Risk C: Monitor

Rotigotine: CNS Depressants may increase sedative effects of Rotigotine. Risk C: Monitor

Suvorexant: CNS Depressants may increase CNS depressant effects of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification

Thalidomide: CNS Depressants may increase CNS depressant effects of Thalidomide. Risk X: Avoid

Tolperisone: May increase adverse/toxic effects of Muscle Relaxants (Centrally Acting). Management: Monitor for increased sedation or CNS effects if tolperisone is combined with other centrally acting muscle relaxants. Consider decreasing the tolperisone dose if these agents are combined. Risk D: Consider Therapy Modification

Trimeprazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Valerian: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Zolpidem: CNS Depressants may increase CNS depressant effects of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider Therapy Modification

Zuranolone: May increase CNS depressant effects of CNS Depressants. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Risk D: Consider Therapy Modification

Pregnancy Considerations

Animal reproduction studies have not been conducted. The manufacturer notes that fetal and congenital abnormalities have been reported following in utero exposure (Hall 1982).

Monitoring Parameters

CNS status; IV site; heart rate and blood pressure with IV administration.

Mechanism of Action

Causes skeletal muscle relaxation by general CNS depression

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Muscle relaxation: Oral: ~30 minutes

Protein binding: 46% to 50%

Metabolism: Hepatic via dealkylation and hydroxylation

Half-life elimination: 1 to 2 hours

Time to peak, serum: Oral: 1 to 2 hours

Excretion: Urine (primarily as metabolites)

Clearance: Adults: 0.2 to 0.8 L/hour/kg

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: Clearance is decreased ~40% in patients with severe renal impairment.

Hepatic function impairment: Clearance is decreased ~70%; t 1/2 is prolonged ~3-fold in cirrhosis patients.

Older adult: The elimination half-life in older adults may be slightly prolonged compared to younger adults (1.5 [± 0.4] hours versus 1.1 [± 0.27] hours, respectively). Additionally, protein binding is slightly decreased in older adults compared to younger adults (41% to 43% versus 46% to 50%, respectively).

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Robaxin;
  • (CH) Switzerland: Metoflex;
  • (CI) Côte d'Ivoire: Lumirelax;
  • (CO) Colombia: Carbarel | Luxafar | Luxakres | Metocarbamol | Mioflex | Plewin | Reflexal | Relansol | Robaxin | Sinaxar;
  • (DE) Germany: Dolovisano Methocarbamol | Methocapuren | Methocarbamol al | Methocarbamol neuraxpharm | Methocarbamol stada | Ortoton | Ortoton forte;
  • (DO) Dominican Republic: Metocarbamol;
  • (EC) Ecuador: Metocarbamol | Metocarbamol mk | Reloxial;
  • (ES) Spain: Robaxin;
  • (FR) France: Lumirelax;
  • (GB) United Kingdom: Methocarbamol aristo | Methocarbamol neuraxpharm | Robaxin;
  • (IE) Ireland: Robaxin;
  • (IN) India: Robinax;
  • (JP) Japan: Carbametin | Methocabal | Methocarbamol mita | Ohlaxin | Robaxin;
  • (KR) Korea, Republic of: Bc methocarbamol | C tri Methocarbamol | Caramol | Carba | Carbamol | Carmol | Carsin | Catar | Catareo | Cmg methocarbamol | Dibefanil | Hanall methocarbamol | Jr methocarbamol | Mebaron | Meca | Mecaba | Medamol | Medoran | Merbamol | Merkan | Meroca | Methoca | Methocaba | Methona | Methosi | Meto | Metocamol | Mimotyl | New-rexan | Quicksmol | Tobaxin;
  • (KW) Kuwait: Robaxin;
  • (LB) Lebanon: Lumirelax;
  • (LV) Latvia: Ortoton;
  • (MX) Mexico: Remisol plus | Rexivin;
  • (NG) Nigeria: Dorbaxin | Kinthomol | Robaxol;
  • (NO) Norway: Ortoton | Robaxin;
  • (PR) Puerto Rico: Robaxin | Robomol;
  • (QA) Qatar: Metoflex;
  • (SA) Saudi Arabia: Robaxin;
  • (TH) Thailand: Fob Carbamol | Laxan | Manic | Mebamol | Metcamol | Methamol | Musxan | Myocin | Myomethol;
  • (TN) Tunisia: Ortoton;
  • (TR) Turkey: Miyokalm;
  • (TW) Taiwan: Bolaxin | Fubaxin | Rebamol | Robaxin | Taspan;
  • (UG) Uganda: Disfor;
  • (VE) Venezuela, Bolivarian Republic of: Metocarbamol;
  • (VN) Viet Nam: Acecontin | Amemoin | Mibelaxol | Oritamol;
  • (ZA) South Africa: Robaxin
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