(FDA approved in bold)

• Muscle spasm
  
• Neck pain/lower back pain
  
• Myofascial pain
  
• Fibromyalgia

• A tricyclic compound with actions similar to tricyclic antidepressants. Blocks serotonin and norepinephrine reuptake pumps and has anticholinergic effects. Acts within the CNS at the brainstem, not at the spinal cord, neuromuscular junction or skeletal muscle level. Reduces tonic somatic motor activity

• Pain – May work within hours but maximal effect occurs in 4–14 days

• Titrate to most effective tolerated dose

• Increase to highest tolerated dose. If ineffective, consider alternative medications or other modalities

• Use other centrally acting muscle relaxants with caution due to potential additive CNS depressant effect
  
• Combine with non-pharmacologic treatments such as exercise/physical therapy, massage, heat/ice or acupuncture

• Consider checking ECG for QTc prolongation at baseline and when increasing dose