Version May 2024
Musculoskeletal conditions: Oral: 250 to 350 mg 3 times daily and at bedtime for a maximum recommended duration of up to 2 to 3 weeks.
Discontinuation in patients on long-term therapy: Although carisoprodol should only be used for short periods (2 to 3 weeks), in patients with a history of long term use or high doses, carisoprodol should be tapered off slowly (eg, over 14 days) to avoid withdrawal symptoms such as anxiety, insomnia, or irritability (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied); carisoprodol undergoes renal excretion and should be used with caution.
Dialysis: Removed by hemodialysis and peritoneal dialysis
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied); carisoprodol undergoes hepatic metabolism and should be used with caution.
Avoid use (Ref).
(For additional information see "Carisoprodol: Pediatric drug information")
Musculoskeletal conditions: Adolescents ≥16 years: Oral: 250 to 350 mg 3 times daily and at bedtime (ie, 4 daily doses); maximum daily dose: 1,400 mg/day; maximum duration of therapy: 3 weeks.
Discontinuation in patients on long-term therapy: Although carisoprodol should only be used for short periods (2 to 3 weeks), experience in adult patients with a history of long-term use or high doses suggests carisoprodol should be tapered off slowly (eg, over 14 days) to avoid withdrawal symptoms such as anxiety, insomnia, or irritability (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied); carisoprodol undergoes renal excretion and should be used with caution.
Dialysis: Removed by hemodialysis and peritoneal dialysis
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied); carisoprodol undergoes hepatic metabolism and should be used with caution.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Central nervous system: Drowsiness (13% to 17%)
1% to 10%: Central nervous system: Dizziness (7% to 8%), headache (3% to 5%)
Postmarketing and/or case reports: Abdominal cramps, agitation, allergic dermatitis, anaphylaxis, angioedema, ataxia, burning sensation of eyes, depression, drug dependence, dyspnea, epigastric pain, eosinophilia, erythema multiforme, exacerbation of asthma, fixed drug eruption, hallucination, headache, hiccups, hypersensitivity reaction, idiosyncratic reaction (symptoms may include agitation, ataxia, confusion, diplopia, disorientation, dysarthria, euphoria, extreme weakness, muscle twitching, mydriasis, temporary vision loss, and/or transient quadriplegia); insomnia, irritability, leukopenia, nausea, orthostatic hypotension, pancytopenia, paradoxical central nervous system stimulation, pruritus, psychosis, seizure, skin rash, syncope, tachycardia, transient flushing of face, tremor, urticaria, vertigo, vomiting, weakness, withdrawal syndrome (abdominal cramps, headache, insomnia, nausea, seizure)
Hypersensitivity to carbamates (eg, meprobamate), or any component of the formulation; history of acute intermittent porphyria
Concerns related to adverse effects:
• CNS depression: May cause CNS depression, which may impair physical or mental abilities; concomitant use of other CNS depressants may enhance these effects. Patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving); in postmarketing reports, motor vehicle accidents have been associated with use. Sedating effects may be potentiated when used with other CNS-depressant drugs or ethanol.
• Seizures: There have been postmarketing reports of seizures with carisoprodol; most cases occurred in the setting of multiple-drug overdoses (including drugs of abuse, illegal drugs, and alcohol).
Disease-related concerns:
• Drug abuse and dependence: Use with caution in patients with a history of drug abuse or acute alcoholism; potential for drug dependency exists. Tolerance, psychological and physical dependence to carisoprodol (and its metabolite, meprobamate) may occur with prolonged use. Limit use to 2 to 3 weeks.
• Hepatic impairment: Use with caution in patients with hepatic impairment; carisoprodol undergoes hepatic metabolism.
• Renal impairment: Use with caution in patients with renal impairment; carisoprodol undergoes renal excretion.
Special populations:
• Poor CYP2C19 metabolizers: Use with caution in patients with reduced CYP2C19 activity; poor metabolizers have been shown to have a fourfold increase in carisoprodol exposure and a 50% reduced exposure to meprobamate (active metabolite) compared to normal metabolizers. Prevalence of poor metabolizers in the Asian population is ~15% to 20% while that of Caucasians and African-Americans is ~3% to 5%.
Other warnings/precautions:
• Withdrawal: May precipitate withdrawal after abrupt cessation of prolonged use. Reported withdrawal symptoms have included insomnia, vomiting, abdominal pain, headache, tremors/twitching, ataxia, hallucinations, and psychosis. Withdrawal symptoms may be due to accumulation of the active metabolite (meprobamate), although carisoprodol may also contribute to the symptoms (Reeves 2010). Although carisoprodol should only be used for short periods (2 to 3 weeks), in patients with a history of long term use or high doses, carisoprodol should be tapered off slowly (eg, over 14 days) to avoid withdrawal symptoms such as anxiety, insomnia, or irritability (Eleid 2010).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Tablet, Oral:
Soma: 250 mg, 350 mg
Vanadom: 350 mg [DSC]
Generic: 250 mg, 350 mg
Yes
Tablets (Carisoprodol Oral)
250 mg (per each): $1.88 - $3.31
350 mg (per each): $0.57 - $10.11
Tablets (Soma Oral)
250 mg (per each): $8.39
350 mg (per each): $12.24
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.
C-IV
May be administered with or without food.
Oral: May be administered with or without food.
Musculoskeletal conditions: Short-term (2 to 3 weeks) treatment of discomfort associated with acute painful musculoskeletal conditions.
Limitations of use: Carisoprodol should only be used for short periods (up to 2 or 3 weeks); adequate evidence of effectiveness for more prolonged use has not been established and acute, painful musculoskeletal conditions are generally of short duration.
Beers Criteria: Carisoprodol 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 by older adults due to anticholinergic effects, risk of sedation, and an increased risk of fracture. In addition, efficacy is questionable at doses tolerated by geriatric patients (Beers Criteria [AGS 2023]).
Substrate of CYP2C19 (major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
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 Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy
Alizapride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Azelastine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Blonanserin: CNS Depressants may enhance the CNS depressant effect 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 enhance the adverse/toxic effect of Botulinum Toxin-Containing Products. Specifically, the risk for increased muscle weakness may be enhanced. Risk C: Monitor therapy
Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Risk C: Monitor therapy
Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Bromopride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Bromperidol: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Buprenorphine: CNS Depressants may enhance the CNS depressant effect 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
Cannabinoid-Containing Products: CNS Depressants may enhance the CNS depressant effect of Cannabinoid-Containing Products. Risk C: Monitor therapy
Chlormethiazole: May enhance the CNS depressant effect 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 enhance the adverse/toxic effect of CNS Depressants. Risk C: Monitor therapy
CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Risk C: Monitor therapy
CYP2C19 Inducers (Moderate): May increase serum concentrations of the active metabolite(s) of Carisoprodol. CYP2C19 Inducers (Moderate) may decrease the serum concentration of Carisoprodol. Risk C: Monitor therapy
CYP2C19 Inducers (Strong): May increase serum concentrations of the active metabolite(s) of Carisoprodol. CYP2C19 Inducers (Strong) may decrease the serum concentration of Carisoprodol. Risk C: Monitor therapy
CYP2C19 Inhibitors (Moderate): May decrease serum concentrations of the active metabolite(s) of Carisoprodol. CYP2C19 Inhibitors (Moderate) may increase the serum concentration of Carisoprodol. Risk C: Monitor therapy
CYP2C19 Inhibitors (Strong): May decrease serum concentrations of the active metabolite(s) of Carisoprodol. CYP2C19 Inhibitors (Strong) may increase the serum concentration of Carisoprodol. Risk C: Monitor therapy
Daridorexant: May enhance the CNS depressant effect 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 enhance the CNS depressant effect 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 enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Doxylamine: CNS Depressants may enhance the CNS depressant effect of Doxylamine. Risk C: Monitor therapy
DroPERidol: May enhance the CNS depressant effect 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
Esketamine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Flunarizine: CNS Depressants may enhance the CNS depressant effect of Flunarizine. Risk X: Avoid combination
Flunitrazepam: CNS Depressants may enhance the CNS depressant effect 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 enhance the CNS depressant effect 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 enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Kava Kava: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Kratom: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Lemborexant: May enhance the CNS depressant effect 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
Lisuride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Lumacaftor and Ivacaftor: May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers). Risk C: Monitor therapy
Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect 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
Metoclopramide: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Risk C: Monitor therapy
Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Nabilone: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Olopatadine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Ombitasvir, Paritaprevir, and Ritonavir: May increase serum concentrations of the active metabolite(s) of Carisoprodol. Ombitasvir, Paritaprevir, and Ritonavir may decrease the serum concentration of Carisoprodol. Risk C: Monitor therapy
Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir: May increase serum concentrations of the active metabolite(s) of Carisoprodol. Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir may decrease the serum concentration of Carisoprodol. Risk C: Monitor therapy
Opioid Agonists: CNS Depressants may enhance the CNS depressant effect 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
Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Risk X: Avoid combination
Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Oxybate Salt Products: CNS Depressants may enhance the CNS depressant effect 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 enhance the CNS depressant effect 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
Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Risk X: Avoid combination
Perampanel: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Piribedil: CNS Depressants may enhance the CNS depressant effect of Piribedil. Risk C: Monitor therapy
Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Risk C: Monitor therapy
Procarbazine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Ropeginterferon Alfa-2b: CNS Depressants may enhance the adverse/toxic effect 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 enhance the sedative effect of ROPINIRole. Risk C: Monitor therapy
Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Risk C: Monitor therapy
Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Risk C: Monitor therapy
Suvorexant: CNS Depressants may enhance the CNS depressant effect 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 enhance the CNS depressant effect of Thalidomide. Risk X: Avoid combination
Tolperisone: May enhance the adverse/toxic effect 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 enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Valerian: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Zolpidem: CNS Depressants may enhance the CNS depressant effect 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 enhance the CNS depressant effect 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
Postmarketing data with meprobamate (the active metabolite) do not show a consistent association between maternal use and an increased risk or pattern of major congenital malformations. In one study, maternal use did not adversely affect mental or motor development, or IQ scores in children exposed in utero.
Carisoprodol and its active metabolite, meprobamate, are present in breast milk.
Carisoprodol levels in breast milk may be 2 to 4 times that of maternal plasma levels. The estimated dose to the infant was reported as 6.9% of the weight-adjusted maternal dose in one case report (Briggs 2008) and ~4% of the weight-adjusted maternal dose in another (Nordeng 2001). In both cases, breast milk production was decreased requiring supplemental formula or cessation of breastfeeding. Other than slight sedation reported in one infant, no symptoms of withdrawal or other adverse events were noted in these two cases. Effects on long-term development are not known. According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother; exposed infants should be monitored for sedation.
CNS effects (eg, mental status, excessive drowsiness); relief of pain and/or muscle spasm; signs of misuse, abuse, and substance use disorder.
Precise mechanism is not yet clear, but many effects have been ascribed to its central depressant actions. In animals, carisoprodol blocks interneuronal activity and depresses polysynaptic neuron transmission in the spinal cord and reticular formation of the brain. It is also metabolized to meprobamate, which has anxiolytic and sedative effects.
Onset of action: Rapid
Duration: 4 to 6 hours
Protein binding: Carisoprodol: <70%; Meprobamate: <25% (Olsen, 1994)
Metabolism: Hepatic, via CYP2C19 to active metabolite (meprobamate)
Half-life elimination: Carisoprodol: ~2 hours; Meprobamate: ~10 hours
Time to peak, plasma: 1.5 to 2 hours
Excretion: Urine, as metabolite
Sex: Carisoprodol exposure is 30% to 50% higher in women than men; however, meprobamate exposure is not affected by gender.
Note: Individuals with reduced CYP2C19 activity have a fourfold increase in carisoprodol exposure and a 50% reduced exposure to meprobamate compared with normal CYP2C19 metabolizers. Prevalence of poor metabolizers in white and black patients is ~3% to 5% and in Asian patients ~15% to 20%.
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