[ Zanaflex use has been associated with hallucinations. If their use is clinically necessary, therapy should be initiated with 2 mg dose and increased in 2–4 mg steps daily based on patient response to therapy. Rats were able to distinguish tizanidine from saline in a standard discrimination paradigm, after training, but failed to generalize the effects of morphine, cocaine, diazepam, or phenobarbital to tizanidine.Tizanidine is closely related to clonidine, which is often abused in combination with narcotics and is known to cause symptoms of rebound upon abrupt withdrawal. Signs and symptoms including respiratory compromise, urticaria, and angioedema of the throat and tongue have been reported. In these patients, during titration, the individual doses should be reduced. Instruct patients to inform their physicians or pharmacists when they start or stop taking any medication because of the risks associated with interaction between Zanaflex and other medicines.Tell patients to take Zanaflex exactly as prescribed (consistently either with or without food) and not to switch between tablets and capsules. The CNS depressant effects of Zanaflex and alcohol are additive. Do not take extra medicine to make up the missed dose.Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.Overdose symptoms may include weakness, drowsiness, confusion, slow heart rate, shallow breathing, feeling light-headed, or fainting.Drinking alcohol with this medicine can cause side effects.This medicine may impair your thinking or reactions. Available for Android and iOS devices. Monitor patients who take Zanaflex with another CNS depressant for symptoms of excess sedation. [ The sedative effects of Zanaflex with CNS depressants (e.g., benzodiazepines, opioids, tricyclic antidepressants) may be additive. The total daily dose should not exceed 36 mg. One patient developed psychosis in association with the hallucinations. Zanaflex is a central alpha-2-adrenergic agonist indicated for the management of spasticity. Consider discontinuing Zanaflex in patients who develop hallucinations.Because of potential drug interactions, Zanaflex is contraindicated in patients taking potent CYP1A2 inhibitors, such as fluvoxamine or ciprofloxacin. Adverse reactions such as hypotension, bradycardia, or excessive drowsiness can occur when Zanaflex is taken with other CYP1A2 inhibitors, such as zileuton, fluoroquinolones other than ciprofloxacin (which is contraindicated), antiarrythmics (amiodarone, mexiletine, propafenone), cimetidine, famotidine, oral contraceptives, acyclovir, and ticlopidine ). Zanaflex should be used with caution in patients with any hepatic impairment.. Do not use this medicine in larger or smaller amounts or for longer than recommended.In most cases you may take Zanaflex up to 3 times in one day if needed. These pharmacokinetic differences may result in clinically significant differences when switching administration of tablet and capsules and when switching administration between the fed or fasted state. Flexeril (cyclobenzaprine) and Zanaflex (tizanidine hydrochloride) are muscle relaxants used to treat muscle tightness and cramping (spasm) caused by acute, painful musculoskeletal conditions. [ The influence of hepatic impairment on the pharmacokinetics of tizanidine has not been evaluated. [ Because hypotensive effects may be cumulative, it is not recommended that Zanaflex be used with other α Zanaflex has not been studied in pregnant women. Consequently when each was administered with food, the amount absorbed from the capsule was about 80% of the amount absorbed from the tablet. Withdrawal symptoms are more likely to occur in cases where high doses are used, especially for prolonged periods, or with concomitant use of narcotics.