A centrally acting skeletal muscle relaxant used as an adjunct to rest, physical therapy, and other measures for the relief of discomfort associated with acute, painful musculoskeletal conditions. Methocarbamol is generally better tolerated than cyclobenzaprine with less sedation and is also available in IV/IM formulations.
Renal impairment (for injectable form due to polyethylene glycol vehicle)
The bottom line
Evidence rating moderate. Most-documented uses: relief of acute musculoskeletal pain and spasm, generally less sedating than cyclobenzaprine, available in iv/im formulation for acute use. 10 sources indexed (2015–2021), with 1 interaction record on file.
The science
How it works, mechanistically.
Core mechanism
The exact mechanism of action is not fully established. Methocarbamol is thought to exert its muscle-relaxant effects through general CNS depression rather than direct action on skeletal muscle, the neuromuscular junction, or the motor nerve. It may inhibit polysynaptic reflexes and has sedative properties that contribute to its clinical effect.1,2
Class
Skeletal Muscle Relaxant
Dosing
Dosing & protocol.
Common range
1500 mg four times daily initially, then 750–1000 mg three to four times daily for maintenance (as prescribed by your physician)
Recommended form
Tablet or IV/IM injection
Can be taken with or without food; may discolor urine to brown, black, or green (harmless)
Safety
Full safety detail.
Side effects
Drowsiness and dizziness
Lightheadedness
Nausea
Blurred vision
Headache
Urine discoloration (brown, black, or green, harmless)
Methocarbamol can cause sedation, dizziness, and impaired coordination, and alcohol can make these effects stronger. The combination can lead to unsafe driving, falls, confusion, and excessive sleepiness. Risk rises when methocarbamol is taken with opioids, benzodiazepines, sleep medicines, or other sedatives.
Recommendation: Avoid alcohol while taking methocarbamol. If you accidentally combine them, avoid driving and do not take additional sedatives. Get medical help for severe confusion, fainting, or breathing problems.
Samsamshariat S, Sharifi-Sade M, Zoofaghari S et al.. Efficacy of the Combination of Indomethacin and Methocarbamol versus Indomethacin Alone in Patients with Acute Low Back Pain: A Double-Blind, Randomized Placebo-Controlled Clinical Trial. Journal of research in pharmacy practice. 2021
Abd-Elsalam S, Arafa M, Elkadeem M et al.. Randomized-controlled trial of methocarbamol as a novel treatment for muscle cramps in cirrhotic patients. European journal of gastroenterology & hepatology. 2019
Friedman BW, Cisewski D, Irizarry E et al.. A Randomized, Double-Blind, Placebo-Controlled Trial of Naproxen With or Without Orphenadrine or Methocarbamol for Acute Low Back Pain. Annals of emergency medicine. 2018
Shabanian G, Shabanian M, Shabanian A et al.. Comparison of atracurium and methocarbamol for preventing succinylcholine-induced muscle fasciculation: A randomized controlled trial. Journal of advanced pharmaceutical technology & research. 2017
Emrich OM, Milachowski KA, Strohmeier M. [Methocarbamol in acute low back pain. A randomized double-blind controlled study]. MMW Fortschritte der Medizin. 2015
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