Soma

What is SOMA?

Soma, with generic name Carisoprodol, is a skeletal muscle relaxant that contains the active ingredient called is meprobamate. Soma is a colorless, crystalline powder with a mild characteristic odor and bitter taste. It is slightly soluble in water and freely soluble in alcohol, chloroform, and acetone.

Directions:

In tablet form, the medication should taken whole by mouth with a glass full of water. There is no need to split, chew or crush them. The tablets and capsules should be swallowed whole and taken with a full glass of water. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Do not take more or less of the medication without your doctor’s approval.

Storage:

* Keep it in its tightly closed container.
* Keep it out of reach of children.
* Store the capsules and tablets at room temperature and away from excess heat and moisture (not in the bathroom).
* Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

Warning:

Before taking Soma, closely consult with your doctor and pharmacist:

* If you are allergic to Soma or any other drugs.
* If you are taking prescription and nonprescription medications.
* If you have or have a pre-existing condition such as kidney or liver disease.
* If you are pregnant, plan to become pregnant, or are breast-feeding.
* If you become pregnant while taking Soma, call your doctor.

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What Is Rheumatoid Arthritis?

Rheumatoid arthritis, or RA, is a systemic inflammatory disease that causes pain, stiffness, swelling and loss of motion in the joints. It is an autoimmune disease – one of many in which, for unknown reasons, a person’s immune system attacks his or her own body tissues. In RA, the immune system attacks the synovium, which is the tissue that lines the joints, causing inflammation in and overgrowth of this tissue.

How Do I Know If I Have RA?

The symptoms of RA vary from person to person and can mimic those of other inflammatory joint conditions, sometimes making the diagnosis difficult. Common RA symptoms include:

* Tender, warm, swollen and stiff joints, often first noticed in the hands and feet and usually symmetrical, e.g., both wrists are affected at the same time.
* Stiffness and pain that are usually worse after waking in the morning and last at least an hour before improving, which occurs with use and motion.
* Symptoms like tiredness, low-grade fever, weight loss and a general feeling of malaise that may develop even before the onset of joint symptoms.
* Systemic effects on other parts of the body such as the tear and salivary glands, lungs, heart and blood vessels.
* Soft lumps called rheumatoid nodules that range in size from a pea to a walnut, which occur in 20 to 30 percent of people with RA.

How Is RA Treated?

RA patients use a combination of treatments to relieve pain, improve mobility and slow down or perhaps even stop damage to the joints. A treatment plan may include:

* Lifestyle modifications: exercise, stress reduction, healthful eating
* Medications including non-steroidal anti-inflammatory drugs (NSAIDs), steroids, disease-modifying anti-rheumatic drugs (DMARDs), and biologic therapies
* Physical therapy
* Surgery to repair damaged joints
* Alternative and complementary therapies such as acupuncture, massage or biofeedback for pain control

Sports-related activities as well as falls and other trauma can injure the cartilage within a joint and, if it is not provided sufficient time to heal, chronic pain and persistent disability can follow. These activities and incidents may increase the risk of osteoarthritis, especially if there’s impact involved or there’s the risk of injury to ligaments. Additionally, damage to the bone surface can start a biological process that results in joint degeneration. This in turn, often leads to rheumatoid arthritis or osteoarthritis.

Arthritis is often a chronic disease meaning it can affect the person afflicted over a long period of time. It cannot be cured, but it can be treated through a variety of methods and products. Learning how to manage your joint pain over the long term is an important factor in controlling the disease and maintaining a good quality of life. This is a brief overview of some of the methods that arthritis sufferers can use to alleviate many of the symptoms associated with arthritis, especially joint pain. Products, both prescription and over-the-counter, for relieving arthritic joint pain are described in Joint Pain Products.

Heat and cold

Heat and/or cold therapy is not recommended to alleviate symptoms associated with all types of arthritis and as such, the decision whether to use it or not should be discussed with your doctor or physical therapist. If your care provider determines that the use of heat and/or cold is appropriate for use on your arthritis pain, it must be determined which kind of temperature treatment should be used. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on affected joint for about 15 minutes may relieve the pain. An ice pack or bag of frozen vegetables wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop the pain. If you have poor circulation, do not use cold packs.

Joint protection

In order to relieve the stress of everyday activity on an afflicted joint, which can exacerbate the condition and may lead to additional injury, a splint or brace can be used to allow joints to rest and keep them from being used. As with many other treatments, a medical care provider such as a physician or physical therapist can make recommendations and possibly provide you with the brace.

Massage

Massage is associated with temporarily relieving joint pain, one of the major symptoms associated with arthritis, rather than treating the underlying cause of a loss of cartilage. A massage therapist will typically lightly stroke and/or knead the muscles around the joint, which increases blood flow to the stressed area. It is important to realize that arthritic joints are very sensitive, so the massage therapist must be familiar with the disease and problems associated with the affected joints.

Exercise

Low-impact exercises such as stretching exercises, swimming, walking, low-impact aerobics, and range-of-motion exercises may reduce joint pain and stiffness while increasing joint mobility. A physical therapist or gym trainer can help plan an exercise program that will give you the most benefit with the least stress on the arthritis-stressed joints.

Weight Reduction

In addition to alleviating some symptoms, the weight loss associated with an exercise program is beneficial in relieving the extra stress that extra pounds put on weight-bearing joints such as the hips and knees. Studies have shown that overweight women who lost approximately 10 pounds substantially reduced the development of osteoarthritis in their knees. In addition, these studies suggested that if osteoarthritis has already affected one joint such as the knee or hip, weight reduction would reduce the chance of it occurring in the other knee or hip. A physical therapist or gym trainer can help plan an exercise program that will give you the most benefit with the least stress on the arthritis-stressed joints.

Transcutaneous electrical nerve stimulation (TENS)

Transcutaneous electrical nerve stimulation uses a small devi ce that is placed near the joint afflicted with arthritis and directs mild electric pulses to nerve endings in and around the arthritic joint. It is theorized that TENS blocks the pain messages sent to the brain from the nerves and modifies the body’s perception of pain. Although TENS relieves some joint pain associated with arthritis, it doesn’t offset the joint inflammation that is associated with arthritis.

Surgery

In some extreme cases of persons with arthritis, surgery may be necessary. The surgeon may perform an operation to remove the synovium, realign the joint, or in extreme cases, replace the damaged joint with an artificial one. Total joint replacement provides not only dramatic pain relief but also significant improvement in joint motion and mobility for many people with arthritis.

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Generic Name: metaxalone (me TAX a lone)
Brand Names: Skelaxin

What is Skelaxin?

Skelaxin is a muscle relaxant. It works by blocking nerve impulses (or pain sensations) in the brain.

Skelaxin is used together with rest and physical therapy to treat skeletal muscle conditions such as pain or injury.

Skelaxin may also be used for other purposes not listed in this medication guide.
What is the most important information I should know about Skelaxin?
Do not use this medication if you are allergic to metaxalone, or if you have anemia (a lack of red blood cells), or severe kidney or liver disease.

Before using Skelaxin, tell your doctor if you are pregnant or breast-feeding.

Use this medication exactly as it was prescribed for you. Do not use it in larger amounts or for longer than recommended by your doctor. Follow the directions on your prescription label.

Skelaxin can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol. It can increase some of the side effects of Skelaxin.

How should I take Skelaxin?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label. Take Skelaxin on an empty stomach, unless your doctor tells you otherwise.

Skelaxin can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using Skelaxin.

Skelaxin is only part of a complete program of treatment that may also include rest, physical therapy, or other pain relief measures. Follow your doctor’s instructions.
Store Skelaxin at room temperature away from moisture and heat.

Skelaxin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using Skelaxin and call your doctor at once if you have any of these serious side effects:

* nausea, stomach pain, loss of appetite
* low fever
* dark urine, clay-colored stools
* jaundice (yellowing of the skin or eyes)

Less serious side effects may include:

* drowsiness, dizziness
* feeling nervous or irritable
* headache
* mild nausea, vomiting, upset stomach
* skin rash

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

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SOMA is indicated for the relief of discomfort associated with acute, painful musculoskeletal conditions in adults. SOMA should only be used for short periods (up to two or three weeks) because adequate evidence of effectiveness for more prolonged use has not been established and because acute, painful musculoskeletal conditions are generally of short duration.

The recommended dose of SOMA is 250 mg to 350 mg three times a day and at bedtime. The recommended maximum duration of SOMA use is up to two or three weeks.

Dosage Forms And Strengths

250 mg Tablets: round, convex, white tablets, inscribed with SOMA 250

350 mg Tablets: round, convex, white tablets, inscribed with SOMA 350.

Storage And Handling

250mg Tablets: round, convex, white tablets, inscribed with SOMA 250; available in bottles of 100 (NDC 0037-2250-10).

350mg Tablets: round, convex, white tablets, inscribed with SOMA 350; available in bottles of 100 (NDC 0037-2001-01).
Storage

Store at 25° C (77° F); excursions permitted between 15° and 30° C (59° and 86° F) (see USP Controlled Room Temperature).

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Opioid analgesics, also known as narcotic analgesics, are pain relievers that act on the central nervous system. Like all narcotics, they may become habit-forming if used over long periods.

Opioid analgesics are used to relieve pain from a variety of conditions. Some are used before or during surgery (including dental surgery) both to relieve pain and to make anesthetics work more effectively. They may also be used for the same purposes during labor and delivery.

Women who are pregnant or plan to become pregnant while taking opioid analgesics should let their physicians know. No evidence exists that these drugs cause birth defects in people, but some do cause birth defects and other problems when given to pregnant animals in experiments. Babies can become dependent on opioid analgesics if their mothers use too much during pregnancy. This can cause the baby to go through withdrawal symptoms after birth. If taken just before delivery, some opioid analgesics may cause serious breathing problems in the newborn.

Some opioid analgesics can pass into breast milk. Women who are breast feeding should check with their physicians about the safety of taking these drugs.

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Generic Name: cyclobenzaprine (sye kloe BEN za preen)
Brand Names:Flexeril

What is Flexeril?

Flexeril is a muscle relaxant. It works by blocking nerve impulses (or pain sensations) that are sent to your brain.

Flexeril is used together with rest and physical therapy to treat skeletal muscle conditions such as pain or injury.

Flexeril may also be used for other purposes not listed in this medication guide.

How should I take Flexeril?

Take this medication exactly as it was prescribed for you. Do not take Flexeril in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Take this medicine with a full glass of water. Do not crush, chew, break, or open an extended-release capsule. Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

Flexeril is only part of a complete program of treatment that may also include rest, physical therapy, or other pain relief measures. Follow your doctor’s instructions.
Store Flexeril at room temperature away from moisture, heat, and light.

Flexeril side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using Flexeril and call your doctor at once if you have any of these serious side effects:

* fast, pounding, or uneven heartbeats
* chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling
* sudden numbness or weakness, especially on one side of the body
* sudden headache, confusion, problems with vision, speech, or balance
* feeling light-headed, fainting
* confusion, weakness, lack of coordination
* nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes)
* seizure (convulsions)
* unusual thoughts or behavior, hallucinations (seeing things)
* easy bruising or bleeding, unusual weakness.

Less serious side effects may include:

* dry mouth or throat
* blurred vision
* drowsiness, dizziness, tired feeling
* loss of appetite, stomach pain, nausea
* diarrhea, constipation, gas
* muscle weakness

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

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Strains, sprains, and other muscle injuries can result in pain, stiffness, and muscle spasms. Muscle relaxants do not heal the injuries, but they do relaxmuscles and help ease discomfort and stop muscle spasms. The muscle relaxantcyclobenzaprine (Flexeril) is also sometimes used to treat fibromyalgia, a condition that involves aches, stiffness, and fatigue.

Muscle relaxants work by acting on the central nervous system. In the UnitedStates, they are available only with a physician’s prescription. Examples of muscle relaxants are carisoprodol (Soma), chlorzoxazone, cyclobenzaprine (Flexeril), and methocarbamol. Most come only in tablet form. However, methocarbamol is available in both tablet and injectable forms. Some muscle relaxants are available in Canada without a prescription.

Muscle relaxants are usually prescribed along with rest, exercise, physical therapy, or other treatments. Although the drugs may provide relief, they should never be considered a substitute for these other forms of treatment. Thesedrugs may make the injury feel so much better that one is tempted to go backto normal activity, but doing too much too soon can actually make the injuryworse.

Muscle relaxants work quite well for relieving muscle pain due to injuries, but are not effective for other types of pain. Some people feel drowsy, dizzy,confused, lightheaded, or less alert when using muscle relaxants drugs. These drugs may also cause blurred vision, clumsiness, or unsteadiness.

Because muscle relaxants work on the central nervous system, they may add tothe effects of alcohol and other drugs that slow down the central nervous system. They may also add to the effects of anesthetics, including those used for dental procedures. For this reason, anyone who takes these drugs should notdrive, operate machinery, or do anything else that might be dangerous untilthey have found out how the drugs affect them.

People with certain medical conditions or who are taking certain other medicines can have problems if they take muscle relaxants. Diabetes should be awarethat the metaxalone (Skelaxin) may cause false test results on one type of test for sugar in the urine. People with epilepsy should be cautioned that taking the muscle relaxant methocarbamol may increase the likelihood of seizures.

Anyone who has allergies, who is breastfeeding has kidney disease, has suffered a recent heart attack or irregular heartbeat, has an overactive thyroid gland, hepatitis or liver disease, is a current or former drug or alcohol abuser, has glaucoma, or has problems with urination should discuss their condition with their doctor before taking muscle relaxants.

The most common side effects or muscle relaxants are vision changes, such asdouble vision or blurred vision; dizziness; lightheadedness; drowsiness; anddry mouth. These problems usually go away as the body adjusts to the drug anddo not require medical treatment. Methocarbamol and chlorzoxazone may causeharmless color changes in urine –orange or reddish-purple with chlorzoxazoneand purple, brown, or green with methocarbamol. The urine will return to itsnormal color when the patient stops taking the medicine.

Less common side effects, such as stomach cramps or pain, nausea and vomiting, constipation, diarrhea, hiccups, clumsiness or unsteadiness, confusion, nervousness, restlessness, irritability, flushed or red face, headache, heartburn, weakness, trembling, and sleep problems also may occur and do not need medical attention unless they do not go away or they interfere with normal activities.

More serious side effects are not common, but may occur. Anyone who experiences breathing problems, facial swelling, fainting, unusually fast or unusuallyslow heartbeat, fever, tightness in the chest, rash, itching, hives, burning, stinging, red, or bloodshot eyes, or unusual thoughts or dreams after taking muscle relaxants should seek medical help promptly

The muscle relaxant chlorzoxazone has caused serious, life-threatening liver problems in some people. The reaction is rare, but anyonetaking the drug should stop taking it and notify his or her physician immediately if any of these symptoms occur: fever, rash, loss of appetite, nausea,vomiting, fatigue, pain in the upper right part of the abdomen, dark urine, or yellow skin or eyes.

Muscle relaxants may interact with some other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effectsmay be greater. Anyone who plans to take muscle relaxants should let the physician know all other medicines, including over-the-counter or nonprescription medicines, that he or she is taking.

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How is it abused?

Abusers typically ingest Soma orally. Many abusers take it in combination with other drugs to enhance the effects of those drugs. Alcohol, codeine, diazepam, heroin, hydrocodone (especially Vicodin), meprobamate, and propoxyphene commonly are abused in combination with Soma. Abusers who combine Soma with Vicodin claim that this combination produces effects similar to those of heroin.

Soma is generally safe when prescribed by a physician and used as directed. However, individuals who abuse Soma can develop psychological addictions to the drug. Common side effects of Soma abuse include blurred vision, dizziness, drowsiness, and loss of coordination. More serious side effects include chills, depression, racing heartbeat, tightness in chest, vomiting, and unusual weakness. Withdrawal symptoms associated with Soma dependency include abdominal cramps, headache, insomnia, and nausea. Signs that an overdose has occurred include difficulty in breathing, shock, and coma. A Soma overdose may result in death.

Is it illegal to abuse Soma?

Yes, abusing Soma is illegal. Reports of Soma abuse have resulted in a number of states scheduling Soma as a controlled substance. States that have taken this action are Alabama, Arizona, Arkansas, Florida, Georgia, Hawaii, Indiana, Kentucky, Minnesota, New Mexico, Oklahoma, Oregon, and West Virginia. Soma is not scheduled at the federal level. However, reports of Soma abuse are being monitored by the Drug Enforcement Administration, and Soma could be listed under the Controlled Substances Act if warranted.

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This review examines the efficacy, side effects, and safety of three commonly prescribed skeletal muscle relaxants metaxalone (Skelaxin), cyclobenzaprine (Flexril), and carisoprodol (Soma).

Skeletal muscle relaxants are commonly used drugs prescribed for the treatment of muscle spasms and discomfort. Muscle relaxants are not really a class of drugs, but rather a group of different drugs that each has an overall sedative effect on the body.

Muscle relaxants treat both muscle spasm and spasticity. These drugs relieve muscle spasms due to low back pain, neck pain, fibromyalgia, tension headaches. They also relieve spasticity due to cerebral palsy, multiple sclerosis, spinal cord injury, or stroke.

* Carisoprodol (brand name: Soma) was approved by the FDA in 1959. Carisoprodol is a muscle relaxant that is used to treat muscle spasms and musculoskelatal pain. Carisoprodol is also a drug treatment option for fibromyalgia symptoms.
* Cyclobenzaprine was FDA approved on August 26, 1977. Cyclobenzaprine is distributed and marketed by McNeil under the brand name Flexeril. Flexeril is one of the strongest muscle relaxants. It has been shown to be beneficial in fibromyalgia, muscle spasms and musculoskelatal pain.
* Metaxalone was approved by FDA on August 13, 1962. This medication is manufactured by by King Pharmaceuticals under the brand name Skelaxin. Skelaxin is indicated as an adjunct to rest, physical therapy, and other measures for the relief of discomforts associated with acute, painful musculoskeletal conditions.

The mechanisms of action of the medications in this class are widely varied and many are not thoroughly understood.

Carisoprodol: The actions of carisoprodol are related to a central nervous system (CNS) mechanism and not to a direct effect on skeletal muscle. Carisoprodol appears to interrupt neuronal communication within the reticular formation and spinal cord. CNS depression produces sedation, and the perception of pain could be altered. Some believe that most of the benefit seen with carisoprodol is secondary to a generalized sedative effect.

Cyclobenzaprine: Since cyclobenzaprine is closely similar to amitriptyline in chemical structure, some of its effects are similar to the tricyclic antidepressants. Cyclobenzaprine relieves muscle spasms through a central action, possibly at the brain stem level, with no direct action on the neuromuscular junction or the muscle involved. It is not a peripheral neuromuscular blocker. Treatment with the drug reduces pain and tenderness, and improves mobility.

Metaxalone: The mechanism of action of metaxalone has not been established. Metaxalone has no direct effect on the contractile mechanism of striated muscle, the motor end plate, or the nerve fiber. Its mode of action may be due to general central nervous system depression.

All three drugs appear to have equal efficacy, but their side effects vary considerably.

Sedation is the most commonly reported adverse effect of muscle relaxants. These medications should be used with caution in people driving motor vehicles or operating heavy machinery. More absolute contraindications do exist to the use of carisoprodol and cyclobenzaprine. By initially prescribing muscle relaxants at bedtime, the physician might take advantage of their sedative effects and minimize daytime drowsiness.

While cyclobenzaprine may not share the dangerous cardiac and neurological potential of its close relatives the TCAs, it does share other properties, particularly confusion, lethargy, and anticholinergic side effects, and may have some toxicity in overdose and in combination with other substances.

Carisoprodol presents the most significant concern, due particularly to its potential for dependence and abuse. Several investigators have called for carisoprodol to be classified as a controlled substance. Carisoprodol is thought to carry an important risk for abuse because of its metabolism to meprobamate.

In the head to head trial of cyclobenzaprine and carisoprodol, dry mouth was more frequent with cyclobenzaprine (38% vs. 10%) and dizziness less frequent (8% vs. 26%). Withdrawal rates due to adverse events were equal (8%).

Metaxalone has the fewest reported side effects of any skeletal muscle relaxants and appears to be the safest.

Key differences among drugs

* Cyclobenzaprine has been evaluated in the most clinical trials and so has the most proof of being effective. Related to TCAs, use with caution in cardiac patients
* Carisoprodol can be addictive.
* Metaxalone is the least likely to cause drowsiness making it more compatible with day time use. Do not use in hepatic dysfunction or patients with history of drug-induced anemia.

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Muscles tend to seize up after an injury (muscle spasm). They do this to protect you from re-injury. While that is certainly a worthy purpose, it can get pretty painful and limiting. Sometimes skeletal muscle relaxants are prescribed in conjunction with physical therapy and rest, to help release the tension. A word of caution, though, while on these medications, you may feel better, but this does not mean it is time for vigorous activity or heavy lifting! Take it slowly - you are healing.

Top 3 Best Muscle Relaxer Medications

1. Skelaxin
Skelaxin is only available in brand form. It is tolerated well by most people, but as with any medication, it is important to tell your doctor your complete medical history, and everything you are taking, including supplements. Because metaxalone is meant for acute injuries, it should not be taken longer than 3 weeks. One side effect to be concerned about is drowsiness, especially if you operate machinery.

2. Carisoprodol - Soma
Carisoprodol is available generically, and also comes in Soma brand.

Carisoprodol is very similar to Skelaxin. Remember is is crucial to talk to your doctor about which medication will be best for you — give him or her your complete history including all medications and supplements you are currently taking.

3. Cyclobenzeprine or Flexeril
Cyclobenzeprine is more tricky to use safely than Skelaxin or carisoprodol. DISCUSS THIS ONE WITH YOUR DOCTOR! If you take MAO inhibitors, as well as some other meds, drug interactions could be serious, even fatal.

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