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Muscle Spasm

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A muscle spasm is an involuntary contraction of a muscle, and is frequently painful. There are many different types of muscle spasms. Some can be addressed through medical means, improvement of diet or physical therapy. Other causes of a muscle spasm may be harder to find and treat.

Some causes of muscle spasm include straining of a muscle, dehydration, trauma, diseases like cerebral palsy or multiple sclerosis (MS), as well as a reaction to certain poisons like strychnine, and damage to nerves or to the spinal cord.

A spasm is a sudden, involuntary contraction of a muscle, a group of muscles, or a hollow organ, or a similarly sudden contraction of an orifice. It is sometimes accompanied by a sudden burst of pain, but is usually harmless and ceases after a few minutes. Spasmodic muscle contraction may also be due to a large number of medical conditions, including the dystonias.

Spasms can occur when a muscle is overused and tired, particularly if it is overstretched or if it has been held in the same position for a prolonged period of time. In effect, the muscle cell runs out of energy and fluid and becomes hyperexcitable and develops a forceful contraction. This spasm may involve part of a muscle, the whole muscle, or even adjacent muscles.

Smooth muscle can also develop spasm. When a hollow structure filled with air or fluid is squeezed by the muscle spasm, significant pain can occur since the fluid or air cannot be compressed. For example, smooth muscle in the intestinal wall can go into spasm, causing waves of pain called colic. Colicky pain which tends to be rhythmic (coming and going) may also occur within the bile duct that empties the gallbladder and may develop after eating. Should a kidney stone attempt to pass, the smooth muscles that are in the walls of the ureter may spasm and cause significant pain. Often this type of pain may be associated with nausea and vomiting. Colicky pain is often associated with diarrhea, where the muscles within the colon wall go into spasm just before the watery bowel movement.

How are muscle spasms treated?

 Medication may used to try to restore balance to the brain’s neurotransmitters. The decision as to which medication to use depends upon the patient’s presentation. It may take trial and error to find the right medication in the right dose to control symptoms.

• Anti-Parkinsonism drugs, like trihexyphenidyl HCl (Artane) and benztropine mesylate (Cogentin) decrease acetylcholine levels.
• Muscle relaxants like Carisoprodol, Generic Soma, diazepam (Valium) and baclofen (Lioresal) affect GABA receptors.
• Levodopa (Sinemet) and reserpine (Harmonyl) affect dopamine levels.
• Carbamazepine (Tegretol), a seizure-control drug, may be useful in some patients.
• Botulinum toxin type A (Botox) may be injected into a specific muscle to paralyze it and relieve the muscle spasm. This was initially used for blepharospasms but is now able to be used where other muscles are involved.

Carisoprodol Dosage for muscle spasms

Usual Adult Dose for Muscle Spasm

250 mg or 350 mg orally 3 times a day and at bedtime

Usual Geriatric Dose for Muscle Spasm

The efficacy and safety of carisoprodol in patients over 65 years old has not been established.

Usual Pediatric Dose for Muscle Spasm

Greater than or equal to 12 years: 250 mg or 350 mg orally 3 times a day and at bedtime

Renal Dose Adjustments

Carisoprodol is excreted by the kidney. To avoid its excess accumulation, caution should be exercised in administration to patients with compromised kidney function.

Liver Dose Adjustments

Carisoprodol is metabolized in the liver. To avoid its excess accumulation, caution should be exercised in administration to patients with compromised liver function.

Precautions

Long-term therapy is not recommended because of the risk of psychologic dependence.

If used chronically at high doses, abrupt discontinuation is not recommended.

Because patients with reduced CYP450 2C19 activity have a greater exposure to carisoprodol, caution is recommended if carisoprodol is used in this patient population.

Dialysis

Carisoprodol is dialyzable by peritoneal and hemodialysis.

Other Comments

The recommended maximum duration of carisoprodol use is up to two or three weeks.