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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

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)

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.

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