If you’re living with rheumatoid arthritis (RA), you may experience muscle spasms, cramps, and aches on top of your other RA symptoms. One treatment option for muscle spasticity (stiffness or tightness) and musculoskeletal pain is a class of prescription drugs called muscle relaxants, or muscle relaxers. These drugs are usually prescribed for acute low back pain, fibromyalgia, multiple sclerosis, and other chronic pain disorders. However, they may also be used for RA and other forms of arthritis.

This article highlights commonly asked questions about using muscle relaxants to treat RA, including those about their safety and effectiveness. Remember to always speak with your rheumatologist before adding any new strategies to your RA treatment plan.

Effectiveness of Muscle Relaxants

There are two classes of muscle relaxants: centrally acting skeletal muscle relaxants (SMRs) and antispastics. SMRs exert their effects on the brain and spinal cord (the central nervous system), causing whole-body side effects. This category of drugs includes:

• Carisoprodol (Soma)
• Chlorzoxazone (Parafon Forte)
• Cyclobenzaprine (Flexeril)
• Metaxalone (Skelaxin)
• Methocarbamol (Robaxin)
• Orphenadrine (Norflex)
• Tizanidine (Zanaflex)

Antispastics, which are used to treat muscle spasticity, include:

• Dantrolene (Dantrium)
• Diazepam (Valium)
• Baclofen (Lioresal)

These muscle relaxants can be either injected or taken orally as pills, tablets, or capsules. Muscle relaxers ease muscle tension and stiffness, which can reduce pain and discomfort.

How Effective Are Muscle Relaxants in Treating RA?

Usually, muscle relaxants are prescribed only when someone living with RA experiences muscle spasms (cramping) or spasticity, causing pain and discomfort. They are usually prescribed when the pain, cramping, and spasticity persist, despite treatment with other, more common RA drugs.

One myRAteam member explained: “I love tizanidine because my legs ache and spasm, and this drug works well.” The effectiveness of muscle relaxants is often supplemented with rest and physical therapy.

Keep in mind that muscle relaxants may not improve pain when taken at a single dose or for a short period, according to a 2012 systematic review that assessed all prior research on muscle relaxants for RA. Results of the meta-analysis were unclear as to whether muscle relaxants, compared with placebo (“sugar pill”), led to functional improvement or better quality of life in people living with RA.

Safety of Muscle Relaxants

The most common side effect of muscle relaxants is drowsiness, so be careful when driving or doing other activities that require mental and physical alertness. One myRAteam member’s hack for this is taking their muscle relaxant “at night before I go to bed. It really does help me relax, especially if I’ve had a lot of pain that day.”

The Arthritis Foundation suggests taking muscle relaxants like cyclobenzaprine two to three hours before you fall asleep to prevent morning grogginess and daytime sedation.

Other common side effects of muscle relaxants include:

• Nausea
• Headache
• Blurry vision
• Dry mouth
• Sexual dysfunction
• Dizziness
• Constipation

Rare side effects include suicidal thoughts, liver inflammation, and a reduced white blood cell count, leading to infection.

Some muscle relaxants can be habit-forming or even addictive, so they are usually prescribed for the short term, beginning with small dosages that are slowly increased. You may experience withdrawal symptoms if you suddenly stop treatment, so your health care provider may taper you off. According to the U.S. Food and Drug Administration (FDA), it is crucial to take muscle relaxants exactly as prescribed to prevent serious side effects.

Is It Safe To Take Muscle Relaxants With RA Drugs?

If you plan on taking muscle relaxants with your other RA medications, it’s important to see if there are any contraindications with common RA drugs.

Disease-modifying antirheumatic drugs (DMARDs) are immunosuppressants, which means they slow the progression of joint damage and inflammation caused by RA. Categories include:

• Conventional DMARDs, such as methotrexate
• Biologics such as adalimumab (Humira)
• Targeted synthetic DMARDs such as baricitinib (Olumiant)

DMARDs are not known to interact with muscle relaxants.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are over-the-counter or prescription medications used for swelling and pain management. NSAID pain medications, or analgesics, commonly used for RA include:

• Naproxen (sold as Aleve, Naprosyn, and Naprelan)
• Acetaminophen (Tylenol)
• Ibuprofen (sold as Advil and Motrin)

One myRAteam member asked, “Who is taking meloxicam and tizanidine? Do you have any side effects, and is it helping you?”

Muscle relaxants are often prescribed with NSAIDs to more effectively treat pain, cramping, and stiffness. There are no known contraindications of these two classes of medications.

Corticosteroids, such as prednisone, are anti-inflammatory and immunoregulatory drugs temporarily prescribed to help reduce chronic pain and inflammation in people with RA. In some cases, your rheumatology team may prescribe muscle relaxants along with corticosteroids for short-term relief.

Overall, muscle relaxants do not interfere with most main RA medications. However, they may interfere with depressive medications that you may be taking for other conditions, such as antidepressants, gabapentin, opioids, and benzodiazepines. Always give your doctor your current medication list before adding any new drugs to your treatment regimen.

Who Should Not Take Muscle Relaxants?

If you and your doctor are weighing the risks and benefits of muscle relaxants for RA treatment, make sure to note that some people should not take muscle relaxants at all. Rules vary for each drug, but here are some general warnings:

• Baclofen cannot be used by people with a stomach ulcer, epilepsy, mental health problems, or diabetes.
• Dantrolene cannot be used by people with liver, heart, or lung problems.
• Diazepam cannot be used by people with severe breathing difficulties.
• Tizanidine cannot be used by older adults or those with liver problems.
• Methocarbamol cannot be used by people with breathing problems, epilepsy, or brain damage.

Currently, there is no strong scientific evidence for rheumatologists to recommend most muscle relaxants to people who are pregnant or breastfeeding. However, none of the existing research on the subject has identified fetal risk in those taking muscle relaxers. If you are pregnant or breastfeeding, talk with your doctor about whether muscle relaxants might be a safe treatment option for you.

Because the effects of muscle relaxants are similar to the depressive effects of alcohol, do not drink while using this class of medications. Doing so can lead to extreme fatigue, impairment in thinking and judgment, and difficulty concentrating.

If you and your doctor think that muscle relaxants should be added to your pain relief regimen, your rheumatology team will find the best option for you based on your RA symptoms, pain intensity, and current medications.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 193,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA. Here, finding ways to manage and time rheumatoid arthritis treatment while improving quality of life is a commonly discussed topic.

Have you taken any muscle relaxants to treat RA symptoms? What was your experience like? Share your experience and advice in the comments below, or start a conversation by posting on your Activities page.