Adjunct to rest, physical therapy, analgesics, and other measures for the relief of discomfort associated with acute, painful musculoskeletal conditions.
For low back pain, generally reserve skeletal muscle relaxants for adjunctive treatment when pain is unresponsive to OTC analgesics (e.g., NSAIAs).
Skeletal muscle relaxants less well tolerated than NSAIAs, and clinical superiority to NSAIAs not established for low back pain.
Various skeletal muscle relaxants appear to have comparable efficacy for low back pain relief and are more effective than placebo.
Initially, symptomatic control of acute low back pain focuses on providing sufficient comfort to allow maximum possible activity while awaiting spontaneous recovery; later, as aid to overcome specific activity intolerance.
Because of rapid spontaneous recovery rate, efficacy of various therapies may be difficult to establish; improvement of low back pain usually occurs within 2 weeks, substantial improvement within 4 weeks.
Ineffective in the treatment of skeletal muscle hyperactivity secondary to chronic neurologic disorders (e.g., cerebral palsy) and other dyskinesias.
Administer orally; may administer IV or IM when oral administration is not feasible or for severe musculoskeletal pain. Do not administer sub-Q.
Switch from parenteral to oral therapy as soon as possible.
Oral Administration
NG Tube
For administration via NG tube, crush tablets and suspend in water or saline solution.
IV Administration
For solution compatibility information, see Compatibility under Stability.
Administer by direct IV injection or by IV infusion.
Patient should be recumbent during and for 10–15 minutes following IV administration.
Avoid extravasation; solution is hypertonic.
For direct IV use, inject undiluted solution slowly to minimize adverse effects.
Blood aspirated into syringe does not mix with methocarbamol injection; either inject any blood in the syringe or stop the injection when the plunger reaches the blood.
Dilution
For IV infusion, dilute 1 g with up to 250 mL of 5% dextrose or 0.9% sodium chloride injection.
Visually inspect diluted solutions for haze prior to administration. (See Stability.)
Rate of Administration
For direct IV injection, maximum rate of 300 mg (3 mL of 10% injection) per minute. Some clinicians have recommended injection at rate of 180 mg/m2 per minute in children.
IM Administration
Administer no more than 500 mg (5 mL of 10% injection) into each gluteal region.
Dosage
Pediatric Patients
Tetanus
IV
Children ≥12 years of age: Recommended minimum initial dose is 15 mg/kg or 500 mg/m2; give additional doses of 15 mg/kg or 500 mg/m2 by direct IV injection or IV infusion every 6 hours, if necessary (maximum 1.8 g/m2 daily for 3 consecutive days).
Adults
Muscular Conditions
Oral
Usual initial dosage is 1.5 g 4 times daily for 2–3 days. For maintenance, decrease dosage to 4–4.5 g daily in 3–6 divided doses.
A few patients may require initial dosage of 8 g daily in divided doses.
IV or IM
Usually, 1 g as a single dose, followed by oral methocarbamol to maintain relief.
For more severe conditions or when oral administration is not feasible, 1 g every 8 hours (maximum 3 g daily for 3 consecutive days). If necessary, may readminister IV or IM after a 2-day drug-free interval.
Tetanus
IV, then Oral
Usual initial dose is 1–2 g by direct IV injection; may administer additional 1–2 g by IV infusion (for maximum total initial dose of 3 g).
Repeat IV infusion of 1–2 g every 6 hours until NG tube can be inserted. Up to 24 g daily (via NG tube) may be required.
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