Carisoprodol

Pronunciation

(kar eye soe PROE dole)

U.S. Brand Names

Soma®

Synonyms

Carisoprodate; Isobamate

Generic Available

Yes

Canadian Brand Names

Soma®

Use

Skeletal muscle relaxant

Use - Dental

Treatment of muscle spasms and pain associated with acute temporomandibular joint pain

Pregnancy Risk Factor

Lactation

Enters breast milk (high concentrations)/not recommended

Contraindications

Hypersensitivity to carisoprodol, meprobamate or any component of the formulation; acute intermittent porphyria

Warnings/Precautions

May cause CNS depression, which may impair physical or mental abilities. Effects with other sedative drugs or ethanol may be potentiated. Use with caution in patients with hepatic/renal dysfunction. Tolerance or drug dependence may result from extended use.

Adverse Reactions

>10%: Central nervous system: Drowsiness

1% to 10%:

Cardiovascular: Tachycardia, tightness in chest, flushing of face, syncope

Central nervous system: Mental depression, allergic fever, dizziness, lightheadedness, headache, paradoxical CNS stimulation

Dermatologic: Angioedema

Gastrointestinal: Nausea, vomiting, stomach cramps

Neuromuscular & skeletal: Trembling

Ocular: Burning eyes

Respiratory: Dyspnea

Miscellaneous: Hiccups

<1%: Ataxia, rash, urticaria, erythema multiforme, aplastic anemia, leukopenia, eosinophilia, blurred vision

Overdosage/Toxicology

Symptoms of overdose include CNS depression, stupor, coma, shock, and respiratory depression. Treatment is supportive.

Drug Interactions

Substrate of CYP2C19 (major)

Increased toxicity: Ethanol, CNS depressants, phenothiazines

CYP2C19 inhibitors: May increase the levels/effects of carisoprodol. Example inhibitors include delavirdine, fluconazole, fluvoxamine, gemfibrozil, isoniazid, omeprazole, and ticlopidine.

Ethanol/Nutrition/Herb Interactions

Ethanol: Avoid ethanol (may increase CNS depression).

Mechanism of Action

Precise mechanism is not yet clear, but many effects have been ascribed to its central depressant actions

Pharmacodynamics/Kinetics

Onset of action: ~30 minutes

Duration: 4-6 hours

Distribution: Crosses placenta; high concentrations enter breast milk

Metabolism: Hepatic

Half-life elimination: 8 hours

Excretion: Urine

Dosage

Oral: Adults: 350 mg 3-4 times/day; take last dose at bedtime; compound: 1-2 tablets 4 times/day

Monitoring Parameters

Look for relief of pain and/or muscle spasm and avoid excessive drowsiness

Patient Education

Take exactly as directed with food. Do not increase dose or discontinue without consulting prescriber. Do not use alcohol, prescriptive or OTC antidepressants, sedatives, and pain medications without consulting prescriber. You may experience drowsiness, dizziness, lightheadedness (avoid driving or engaging in tasks requiring alertness until response to drug is known); nausea, vomiting, or cramping (small, frequent meals, frequent mouth care, or sucking hard candy may help); or postural hypotension (change position slowly when rising from sitting or lying or when climbing stairs). Report excessive drowsiness or mental agitation; palpitations, rapid heartbeat, chest pain; skin rash; muscle cramping or tremors; or respiratory difficulty. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Breast-feeding is not recommended.

Nursing Implications

Raise bed rails; institute safety measures; assist with ambulation

Dental Health: Effects on Dental Treatment

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

Drowsiness is common; may produce depression or paradoxical CNS stimulation

Mental Health: Effects on Psychiatric Treatment

Rarely may cause leukopenia or aplastic anemia; use caution with clozapine and carbamazepine; concurrent use with psychotropics may produce additive sedation

Dosage Forms

Tablet: 350 mg

References

Adams HR, Kerzee T, and Morehead CD, "Carisoprodol-Related Death in a Child," J Forensic Sci , 1975, 20:200-2.

Backer RC, Zumwalt R, McFeeley P, et al, "Carisoprodol Concentrations From Different Anatomical Sites: Three Overdose Cases," J Anal Toxicol , 1990, 14(5):332-4.

Goldberg D, "Carisoprodol Toxicity," Milit Med , 1969, 34:597-601.

Luehr JG, Meyerle KA, and Larson EW, "Mail-Order (Veterinary) Drug Dependence," JAMA , 1990, 263(5):657.

International Brand Names

Artifar® (GR); Carisoma® (GB, IN); Carisoprodol Sintesina® (AR); Listaflex® (AR); Mio Relax® (ES); Sanoma® (DE); Soma® (CA); Somadril® (DK, NO, SE); Somflam® (IN)

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