Methocarbamol and tizanidine

Non-benzodiazepines include a variety of drugs that can act at the brain stem or spinal cord level. Examples include carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, tizanidine, and orphenadrine. All antispasmodic agents can cause significant drowsiness, dizziness, confusion, nausea, and vomiting.

Pain management is a high priority for patients with rheumatoid arthritis (RA). Muscle relaxants include drugs that reduce muscle spasm (for example benzodiazepines such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan) and non-benzodiazepines such as metaxalone (Skelaxin) or a combination of paracetamol and orphenadrine (Muscol)) and drugs that prevent increased muscle tone ... methocarbamol, chlorzoxazone, baclofen, or dantrolene compared to placebo in patients with musculoskeletal conditions. There is insufficient evidence to determine the relative efficacy or safety of cyclobenzaprine, carisoprodol, orphenadrine, tizanidine, metaxalone, methocarbamol, and chlorzoxazone. Dantrolene, and to a lesser degree ...Carisoprodol, cyclobenzaprine, metaxalone, methocarbamol, thiocolchicoside, tizanidine, tolperisone, orphenadrine Benzodiazepines To reduce acute muscle spasm commonly associated with muscle injury. These drugs also have a strong sedative action as well as anxiolytic, hypnotic, and anticonvulsant actions DiazepamJan 29, 2020 ... Muscle relaxants Methocarbamol vs Tizanidine are the go-tos when it comes to muscle spasm and spasticity medications. This does not dispute the ...Carisoprodol, cyclobenzaprine, metaxalone, methocarbamol, thiocolchicoside, tizanidine, tolperisone, orphenadrine Benzodiazepines To reduce acute muscle spasm …

The other medications listed here may not raise tizanidine levels as much. But you should talk to your healthcare provider before taking them. They can help you weigh the risks and benefits. They might consider lowering your tizanidine dose. Or they may just ask you to watch out for tizanidine side effects. 2. Birth control pillsMethocarbamol Methocarbamol is a muscle relaxer that works by calming your nervous system. After you start taking it, you’ll usually take 750 mg or 1,000 mg by mouth 3 or 4 times per day. It can be used by people ages 16 and older. Reproductive studies for methocarbamol haven’t been done in animals.Comparing Robaxin vs Tizanidine. Robaxin (methocarbamol) Tizanidine. Prescription only. Prescribed for Muscle Spasm, Tetanus. Robaxin may also be used for purposes not listed in this medication guide. Prescription only. Tizanidine relieves muscle spasms but may cause sleepiness, a drop in blood pressure, and sedation.METHOCARBAMOL: Central nervous system: hydrocodone: ondansetron: 2.14: 1.13–4.09: TIZANIDINE: Cardiovascular: atorvastatin: gabapentin: 1.45: 1.06–1.98: losartan: …Jan 30, 2017 · Muscle relaxants are used to treat two different conditions: (1) spasticity from upper motor neuron syndromes as occurs in multiple sclerosis and (2) muscular pain or spasms from peripheral musculoskeletal diseases or injury such as low back pain. The muscle relaxants in current use have variable mechanisms of action, efficacy and adverse effects. Popular comparisons. Baclofen has an average rating of 7.0 out of 10 from a total of 434 ratings on Drugs.com. 61% of reviewers reported a positive effect, while 24% reported a negative effect. Robaxin-750 has an average rating of 6.1 out of 10 from a total of 42 ratings on Drugs.com. 44% of reviewers reported a positive effect, while 28% ...

Jun 20, 2020 ... The sedative properties of tizanidine and cyclobenzaprine may benefit patients with insomnia caused by severe muscle spasms. Methocarbamol and ...More about Tizanidine. Ratings & Reviews. Cyclobenzaprine has an average rating of 5.9 out of 10 from a total of 617 ratings on Drugs.com. 47% of reviewers reported a positive effect, while 31% reported a negative effect. Tizanidine has an average rating of 6.1 out of 10 from a total of 377 ratings on Drugs.com. 48% of reviewers reported a ...Tizanidine. Tizanidine has both antispasmodic and antispastic effects. ... Methocarbamol is an OTC nonbenzodiazepine, antispasmodic medication. A common brand name for it in the U.S. is Robaxin.For example, tizanidine and baclofen could be taken preoperatively including the day of surgical procedure, whereas other SMRs (methocarbamol, orphenadrine, metaxalone, …Methocarbamol (meth" oh kar' ba mol) is a guaifenesin derivative and acts centrally as a muscle relaxant by an unknown mechanism. Methocarbamol was approved for use in the United States in 1957, and currently more than 3 million prescriptions are filled yearly. Methocarbamol is indicated for the relief of acute, painful musculoskeletal ...Welcome to the Introduction to Gabapentin Neurontin. Gabapentin, also known аs Neurontin, is an anticonvulsant medication used to treat seizures and nerve pain. It works by affecting chemicals and nerves in the body. Gabapentin is available in various forms, including oral solution, cаpsules, and extended-release tablets.

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The tizanidine/diazepam comparison of Rinne 1980 showed no significant difference in the efficacy of the two drugs but more weakness and drowsiness with diazepam; tizanidine was generally preferred. Jellinger 1983 noted improvement in muscle tone, spasms and clonus more frequently in those taking tizanidine (assessment …Dec 17, 2008 ... ... methocarbamol (Robaxin), orphenadrine, and tizanidine. (Zanaflex). There is fair evidence that baclofen, tizanidine, and dantrolene are ...The full list of muscle relaxants used in our cohort included baclofen, dantrolene, metaxalone, carisoprodol, chlorzoxazone, cyclobenzaprine, methocarbamol, tizanidine, or orphenadrine. Diagnoses Associated With Muscle Relaxant UseLast updated on 11 February 2012 by Rajive Goel. My Dr recently abruptly stopped my Soma Rx & replaced w/ Zanaflex. Thanks 2 all the info & help I got here, he's willing 2 prscribe it again at next appt if I try Robaxin (those r the only 2 I haven't tried. I searched & can't find anything on taking Zanaflex & Robaxin 750 at the same time.

May 19, 2023 ... Methocarbamol is a muscle relaxant medication that works by reducing muscle spasms and pain. It is not known to cause serotonin syndrome, as it ...Apr 26, 2023 · The FDA has not approved tizanidine to treat neck or back pain. For multiple sclerosis or cerebral palsy, tizanidine tends to have fewer side effects than Baclofen. But either medication may not make much difference in new low back pain when compared with ibuprofen alone. Tizanidine is not a first choice for new neck or back muscle pain. 6 ... Methocarbamol isn’t a narcotic. It’s a central nervous system (CNS) depressant and muscle relaxant used to treat muscle spasms, tension, and pain. It may be mistaken for a narcotic due to side ...Methocarbamol is Robaxin,I take 2/ 750mg a day. Tizanidine is Zanaflex,they took me off it 2 years ago because it can cause liver damage.Both are muscle relaxers.I could get a really good night sleep with the Zanaflex.They only had me on 4mg.As long as they do blood work on liver function you may be alright, but I have not heard. of Doctors ...Nov 21, 2022 · The other medications listed here may not raise tizanidine levels as much. But you should talk to your healthcare provider before taking them. They can help you weigh the risks and benefits. They might consider lowering your tizanidine dose. Or they may just ask you to watch out for tizanidine side effects. 2. Birth control pills Can tizanidine hcl 4 mg be taken along with clonazepam 0.5 mg? There are known drug reactions between tizanidine and clonazepam. Never take them together unless you do so under the supervision of ...More about Flexeril ( cyclobenzaprine ) Ratings & Reviews. Tizanidine has an average rating of 6.1 out of 10 from a total of 377 ratings on Drugs.com. 48% of reviewers reported a positive effect, while 30% reported a negative effect. Flexeril has an average rating of 6.0 out of 10 from a total of 237 ratings on Drugs.com. 47% of reviewers ...Muscle relaxers aren’t a first-line treatment for migraine. Still, a doctor or healthcare professional may prescribe certain muscle relaxers, such as tizanidine, to treat migraine or other types of headaches. But in most cases, the risks may outweigh the benefits. Migraine is a debilitating, intense form of headache that usually affects one ...Methocarbamol, sold under the brand name Robaxin among others, is a medication used for short-term musculoskeletal pain. It may be used together with rest, physical therapy, and pain medication. It is less preferred in low back pain. It has limited use for rheumatoid arthritis and cerebral palsy. Effects generally begin within half an hour. It is taken by …Methocarbamol vs Tizanidine. Muscle relaxants Methocarbamol vs Tizanidine are the go-tos when it comes to muscle spasm and spasticity medications. This does not dispute the efficacy of Robaxin generic versions. Zanaflex is a brand name for Tizanidine and is also a prescription medication; hence care should be taken when …Muscle relaxants used in dystonia include cyclobenzaprine, tizanidine, metaxalone, carisoprodol, methocarbamol, orphenadrine, and chlorzoxazone [34, 35], with evidence for their use derived only from anecdotal use or case reports.

Methocarbamol. Cyclobenzaprine. Tizanidine. Prescription only. Methocarbamol is only given when other treatments for musculoskeletal pain have not worked. Its main side effect is drowsiness and it should not be used in children or seniors. Prescribed for Muscle... more. Prescription only. Cyclobenzaprine is a muscle relaxant that may be used ...

Methocarbamol is a central-acting muscle relaxant used to treat skeletal muscle spasms and pain related to severe muscle spasm. It is also associated with ...Only three muscle relaxants - baclofen, dantrolene, and tizanidine are FDA approved to treat spasticity; however, six ( carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, and orphenadrine) are approved to treat muscle spasm. Botulinum toxin is only approved to treat spasticity in certain muscle groups of the upper and ...This review included other muscle relaxants such as metaxalone, baclofen, tizanidine, orphenadrine, and chlorzoxazone. In a head-to-head trial between methocarbamol and cyclobenzaprine, there was no significant difference in muscle spasms or tenderness. However, patients experienced slightly better improvements in local pain with ...The LactMed® database contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where …Generic Name Tizanidine DrugBank Accession Number DB00697 Background. Tizanidine is a fast-acting drug used for the management of muscle spasm, which may result from the effects of multiple sclerosis, stroke, an acquired brain injury, or a spinal cord injury 9.It may also be caused by musculoskeletal injury 5.Regardless of the cause, muscle spasticity …Methocarbamol Methocarbamol is a muscle relaxer that works by calming your nervous system. After you start taking it, you’ll usually take 750 mg or 1,000 mg by mouth 3 or 4 times per day. It can be used by people ages 16 and older. Reproductive studies for methocarbamol haven’t been done in animals.From the perspective of new and potential therapeutic uses, tizanidine has additional benefits (eg, gastroprotection that can improve patient tolerance to …The LactMed® database contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate. All data are derived from the scientific ...

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lightheadedness, dizziness, or fainting. loss of appetite. loss of bladder control. loss or problems with memory. nausea. numbness or tingling of face, hands, or feet. pain, tenderness, or swelling of foot or leg. painful or difficult urination. puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue.The primary indications for cyclobenzaprine, metaxolone, methocarbamol, and carisoprodol are acute painful musculoskeletal conditions. 16 Baclofen and tizanidine are indicated for spasticity associated with UMN disorders, but are frequently used off-label for painful musculoskeletal conditions. Diazepam is indicated for UMN muscle spasticity ...With more than 40 million "experiences" (they don't call them games) to choose from, there's something for everyone in Roblox. Take this quiz to learn more. Advertisement Advertise...More about Flexeril ( cyclobenzaprine ) Ratings & Reviews. Tizanidine has an average rating of 6.1 out of 10 from a total of 377 ratings on Drugs.com. 48% of reviewers reported a positive effect, while 30% reported a negative effect. Flexeril has an average rating of 6.0 out of 10 from a total of 237 ratings on Drugs.com. 47% of reviewers ...1) Methocarbamol (Robaxin) An inexpensive and relatively less sedating option, methocarbamol has been well studied for use in back pain. In recent studies where it was used for up to eight days, 44% of folks that took methocarbamol had complete pain relief (compared to 18% who took nothing)—and that was without any serious side effects.Tizanidine has been associated with liver toxicity and hypotension in some patients. Baclofen is tapered over 1-2 weeks to prevent development of psychoses and hallucinations. Interactions. The following are drug-drug interactions involved in the use of centrally acting muscle relaxants: Other CNS depressants, alcohol: increased CNS …Popular comparisons. Baclofen has an average rating of 7.0 out of 10 from a total of 434 ratings on Drugs.com. 61% of reviewers reported a positive effect, while 24% reported a negative effect. Robaxin-750 has an average rating of 6.1 out of 10 from a total of 42 ratings on Drugs.com. 44% of reviewers reported a positive effect, while 28% ... More about Methocarbamol. Ratings & Reviews. Cyclobenzaprine has an average rating of 5.9 out of 10 from a total of 617 ratings on Drugs.com. 47% of reviewers reported a positive effect, while 31% reported a negative effect. Methocarbamol has an average rating of 6.3 out of 10 from a total of 297 ratings on Drugs.com. 51% of reviewers reported ... The brand name of this medication is Robaxin®. What is this medication? METHOCARBAMOL (meth oh KAR ba mole) treats muscle pain and stiffness.Comparing Robaxin vs Tizanidine. Robaxin (methocarbamol) Tizanidine. Prescription only. Prescribed for Muscle Spasm, Tetanus. Robaxin may also be used for purposes not listed in this medication guide. Prescription only. Tizanidine relieves muscle spasms but may cause sleepiness, a drop in blood pressure, and sedation. ….

Popular comparisons. Baclofen has an average rating of 7.0 out of 10 from a total of 434 ratings on Drugs.com. 61% of reviewers reported a positive effect, while 24% reported a negative effect. Robaxin-750 has an average rating of 6.1 out of 10 from a total of 42 ratings on Drugs.com. 44% of reviewers reported a positive effect, while 28% ...Apr 4, 2023 · Tizanidine relaxes muscles by dampening down nerve impulses that are sent from spasming muscles along nerve fibers to the brain. Tizanidine belongs to the class of medicines known as central alpha-2-adrenergic agonists. It may also be called a centrally-acting muscle relaxant. 2. May 13, 2022 ... For the four most used SMRs, we included 35 940, 12 167, 7981 and 6054 users of cyclobenzaprine, tizanidine, baclofen and methocarbamol, and ...Methocarbamol is only given when other treatments for musculoskeletal pain have not worked. Its main side effect is drowsiness and it should not be used in children or seniors. Prescribed for Muscle... more. Prescription only. Tizanidine relieves muscle spasms but may cause sleepiness, a drop in blood pressure, and sedation.There is insufficient evidence to determine the relative efficacy or safety of cyclobenzaprine, carisoprodol, orphenadrine, tizanidine, metaxalone, methocarbamol, and …Methocarbamol (Robaxin) is an oral medication used to treat muscle pain and stiffness. Learn about side effects, warnings, dosage, and more.Pregabalin capsule and oral liquid are also used to treat a condition called fibromyalgia (muscle pain and stiffness). Pregabalin works in the central nervous system (CNS) to control seizures and pain. It is an anticonvulsant and neuropathic pain agent. This medicine is available only with your doctor's prescription.Key takeaways: Tramadol (Ultram, ConZip, Qdolo) is an opioid medication used to treat pain. It has many possible drug interactions, including some antidepressants, antibiotics, and diuretics. Some …Apr 19, 2024 · Possible Side Effects and Risks. As with all drugs, muscle relaxers can cause side effects. The one possible side effect common to all muscle relaxers is dizziness and drowsiness, although some cause greater drowsiness than others. Common side effects of muscle relaxants (by drug class) include: Benzodiazepines. Drowsiness. Methocarbamol and tizanidine, Jul 13, 2023 · Store your methocarbamol tablets at room temperature, 68 to 77F (20 to 25C). 6. Response and effectiveness. Methocarbamol starts working in about 30 minutes and its full effects are seen within 2 hours. Methocarbamol is relatively short-acting and needs to be taken three to four times a day as directed by a doctor. 7. Interactions , Methocarbamol And Alcohol. Methocarbamol and alcohol act on the nervous system. The former works by blocking nerve impulses (pain sensations) that are being sent to the brain while the latter works by altering the membranes of the brain, which leads to sedation and reduction of pain. Moreover, Robaxin’s primary use is muscle …, Methocarbamol is a central-acting muscle relaxant used to treat skeletal muscle spasms and pain related to severe muscle spasm. It is also associated with ..., By Alan Sembera You can speed up or slow down the playback speed of almost any YouTube video using YouTube's own alternative HTML5 Video Player. The player contains a playback-spee..., If you have a car that does not have a built-in system, you will need acell phone car mount. Here are the top cell phone car mounts. If you buy something through our links, we may ..., Jul 7, 2019 ... Depends on the individual. Cyclobenzaprine Flexeril is a muscle relaxer similar to the tricyclic antidepressants. Methocarbanol Robaxin is a ..., Tizanidine and diazepam have anti-spastic and anti-spasmodic properties. These anti-spastic and anti-spasmodic medications have different mechanisms of action; for the scope of this review, we shall focus on methocarbamol. Methocarbamol was discovered in the early 1950s and was approved for use in 1957., Some muscle relaxants (carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, and orphenadrine) are avoided in older adults due to risk for sedation and falls. Others (tizanidine, baclofen, dantrolene) may be helpful for neck and back pain, with the most evidence for tizanidine and baclofen. These should be used ..., Tizanidine and diazepam have anti-spastic and anti-spasmodic properties. These anti-spastic and anti-spasmodic medications have different mechanisms of action; for the scope of this review, we shall focus on methocarbamol. Methocarbamol was discovered in the early 1950s and was approved for use in 1957., Apr 1, 2024 · For oral dosage forms (capsules or tablets): For muscle relaxation: Adults—At first, 2 milligrams (mg) every 6 to 8 hours. Your doctor may adjust your dose as needed. Do not take more than 36 mg within a 24-hour period. Children—Use and dose must be determined by your doctor. , dantrolene, diazepam, metaxalone, methocarbamol, orphenadrine, and tizanidine. Outcomes assessed in the review included improvement in functional outcomes, muscle tension, stiffness, daily living activity, sleep impairment, and pain severity.3 In terms of adverse effects between SMR,, methocarbamol, chlorzoxazone, baclofen, or dantrolene compared to placebo in patients with musculoskeletal conditions. There is insufficient evidence to determine the relative efficacy or safety of cyclobenzaprine, carisoprodol, orphenadrine, tizanidine, metaxalone, methocarbamol, and chlorzoxazone. Dantrolene, and to a lesser degree ..., The 1957-1959 Chrysler New Yorker flaunted the bold new re-design of the Chrysler line in the 1950s. Learn about the 1957-1959 Chrysler New Yorker. Advertisement The 1957-1959 Chry..., Muscle relaxants used in dystonia include cyclobenzaprine, tizanidine, metaxalone, carisoprodol, methocarbamol, orphenadrine, and chlorzoxazone [34, 35], with evidence for their use derived only from anecdotal use or case reports., Some work in the brain or spinal cord to block or dampen down excessively stimulated nerve pathways. These are called centrally acting muscle relaxants and examples include baclofen, methocarbamol, and tizanidine. Others act directly on muscle fibers and are classified as peripherally acting muscle relaxants., Oct 23, 2020 · Muscle relaxants used in dystonia include cyclobenzaprine, tizanidine, metaxalone, carisoprodol, methocarbamol, orphenadrine, and chlorzoxazone [34, 35], with evidence for their use derived only from anecdotal use or case reports. , Methocarbamol And Alcohol. Methocarbamol and alcohol act on the nervous system. The former works by blocking nerve impulses (pain sensations) that are being sent to the brain while the latter works by altering the membranes of the brain, which leads to sedation and reduction of pain. Moreover, Robaxin’s primary use is muscle …, The LactMed® database contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where …, Jul 13, 2023 · Store your methocarbamol tablets at room temperature, 68 to 77F (20 to 25C). 6. Response and effectiveness. Methocarbamol starts working in about 30 minutes and its full effects are seen within 2 hours. Methocarbamol is relatively short-acting and needs to be taken three to four times a day as directed by a doctor. 7. Interactions , The most evidence for the use of skeletal muscle relaxers in treating low back pain is with the use of cyclobenzaprine.⁵ One small study showed that cyclobenzaprine plus naproxen resulted in a significant decrease in muscle spasms and tenderness compared to naproxen alone.⁶ Evidence for the use of tizanidine comes from a …, Tizanidine is a centrally acting alpha-2 agonist with muscle-relaxant, sedative, and anxiolytic properties. It has been used to treat pain associated with muscle spasms, and myofascial and neuropathic pain [34-36]. In 2016, Yazicioğlu et al. studied tizanidine use after inguinal hernia repair in a randomized double-blind study. The primary ..., There is insufficient evidence to determine the relative efficacy or safety of cyclobenzaprine, carisoprodol, orphenadrine, tizanidine, metaxalone, methocarbamol, and …, Muscle relaxants are used to treat two different conditions: (1) spasticity from upper motor neuron syndromes as occurs in multiple sclerosis and (2) muscular pain or spasms from peripheral musculoskeletal diseases or injury such as low back pain. The muscle relaxants in current use have variable mechanisms of action, efficacy and adverse effects., Apr 28, 2020 · This review included other muscle relaxants such as metaxalone, baclofen, tizanidine, orphenadrine, and chlorzoxazone. In a head-to-head trial between methocarbamol and cyclobenzaprine, there was no significant difference in muscle spasms or tenderness. However, patients experienced slightly better improvements in local pain with ... , The sedative properties of tizanidine and cyclobenzaprine may benefit patients with insomnia caused by severe muscle spasms. Methocarbamol and metaxalone are less …, Methocarbamol. Carisoprodol. Metaxalone. Tizanidine. Orphenadrine. Baclofen. Dantrolene (Dantrium) Diazepam. These muscle relaxers share several similarities, but there are also some differences. For example, most muscle relaxers are known to cause drowsiness. But methocarbamol may be less likely than cyclobenzaprine or tizanidine to cause ..., More about Methocarbamol. Ratings & Reviews. Cyclobenzaprine has an average rating of 5.9 out of 10 from a total of 617 ratings on Drugs.com. 47% of reviewers reported a positive effect, while 31% reported a negative effect. Methocarbamol has an average rating of 6.3 out of 10 from a total of 297 ratings on Drugs.com. 51% of reviewers reported ... , Tizanidine: An overlooked alternative muscle relaxant for older patients. Emmanuel M. Knight Pharm.D, Corresponding Author. Emmanuel M. Knight Pharm.D [email protected] Department of Pharmaceutical Services, University of California Los Angeles, Santa Monica Medical Center, Santa Monica, California, USA., Some work in the brain or spinal cord to block or dampen down excessively stimulated nerve pathways. These are called centrally acting muscle relaxants and examples include baclofen, methocarbamol, and tizanidine. Others act directly on muscle fibers and are classified as peripherally acting muscle relaxants., Methocarbamol (Robaxin)6. Orphenadrine (Norflex)7. Tizanidine (Zanaflex)8,9 Adults: 250 to 750 mg three to four times daily Children: 125 to 500 mg three to four times daily; or 20 mg per kg..., Using tiZANidine together with methocarbamol may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol during treatment., Summary. Prescription only. Methocarbamol (Robaxin) is a muscle relaxer. It's used to treat muscle pain and discomfort, like back pain, in people ages 16 years and older. It works best when used along with non-medication treatments, such as rest and physical therapy. Methocarbamol is taken by mouth, typically 3 or 4 times daily., For oral dosage forms (capsules or tablets): For muscle relaxation: Adults—At first, 2 milligrams (mg) every 6 to 8 hours. Your doctor may adjust your dose as needed. Do not take more than 36 mg within a 24-hour period. Children—Use and dose must be determined by your doctor.