Problem

Find another product name for each of the muscle relaxants listed in the Representative Dr...

Find another product name for each of the muscle relaxants listed in the Representative Drugs table on pages 414–416 of this text.

Representative Drugs for the Musculoskeletal System

Category, Namea, and Route	Uses and Diseases	Actions	Usual Doseb and Special Instructions	Side Effects and Adverse Reactions
Tumor Necrosis Factor-Alpha Drugs
Adalimumab (Humira) Subcutaneous	May be used alone or with methotrexate to decrease the symptoms of rheumatoid arthritis to improve physical function and inhibit the progression of structural damage	Tumor necrosis factor-alpha (TNF-alpha) or immunomodulator binds to TNF-alpha and blocks interaction with certain cell surface receptors, which results in a decrease in the inflammation, erythrocyte sedimentation rate, and serum cytokines	40 mg subcutaneously every other week	Serious infections and sepsis in patients receiving immunosupressants, nausea, vomiting, abdominal pain, confusion, headache, hypertension, urinary tract infections
Etanercept (Enbrel) Subcutaneous	Decreases the symptoms and delays structural damage while improving physical functioning in moderate to severe rheumatoid arthritis	Binds to tumor necrosis factor and blocks its interaction with cell surface TNF receptors	50 mg subcutaneously every other week	Abdominal pain, nausea, vomiting, altered taste sensation, headache, dizziness, depression, upper respiratory infections, ocular inflammation, dry eyes, peripheral edema, anorexia, weight gain
Anti-Inflammatory Drugs (Antiarthritics)
Aspirin Oral, suppository	Mild to moderate pain, inflammatory diseases (e.g., osteoarthritis)	Reduces pain (analgesic), inflammation (anti-inflammatory), and fever (antipyretic); inhibits prostaglandin synthesis	Mild pain: 325–650 mg every 4 hours prn Rheumatoid arthritis: 3.6–5.4 g daily in divided doses; give oral forms with food, milk, or full glass of water to avoid stomach irritation unless enteric coated	Nausea, stomach pain, indigestion, gastrointestinal bleeding; overdose: tinnitis, rapid breathing, dizziness, severe headache
Nonsteroidal Anti-Inflammatory Drugs
Ibuprofen (Motrin, prescription; Nuprin, Advil, OTC) Oral	Rheumatoid arthritis, osteoarthritis, mild to moderate pain	Reduces pain, inflammation, fever; inhibits prostaglandin synthesis	200–800 mg po tid or qid, adjusted individually; give with milk or food if stomach irritation occurs; takes up to 2 weeks to show effects; if no relief in 2 weeks, consult physician	Epigastric distress, nausea, headache, dizziness, tinnitus, rash, visual disturbances, gastrointestinal bleeding, renal impairment
Naproxen (Naprosyn) Oral	Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, tendonitis, bursitis, acute gout	Inhibits prostaglandin synthesis; is an anti-inflammatory agent with antipyretic and analgesic effects	250–500 mg bid in morning and evening for rheumatoid arthritis, osteoarthritis, ankylosing spondylitis; for gout: 750 mg, then 250 mg every 8 hours until attack subsides	Gastrointestinal bleeding, heartburn, nausea, headache, dizziness, itching, tinnitis, edema
Celecoxib (Celebrex) Oral	Acute and chronic rheumatoid arthritis, osteoarthritis (COX-2 inhibitors)	Inhibits prostaglandin synthesis; has analgesic, anti-inflammatory, and antipyretic properties	100–200 mg po bid	Tachycardia, fatigue, anxiety, depression, nausea, vomiting, constipation, dry mouth, nephrotoxicity, hematuria, blood dyscrasias
Indomethacin (Indocin) Oral	Moderate to severe rheumatoid arthritis including acute flare-ups of chronic disease, moderate to severe ankylosing spondylitis, moderate to severe osteoarthritis, bursitis, tendonitis, acute gouty arthritis	Inhibits prostaglandin synthesis; is an antiinflammatory agent with ability to relieve pain, swelling, fever of arthritis	25–50 mg bid-tid; may increase by 25 mg daily; do not exceed 200 mg daily	Nausea, vomiting, indigestion, dizziness, headache, fatigue, tinnitis, renal impairment, gastrointestinal bleeding
Gold
Auranofin (Ridaura) Oral	Rheumatoid arthritis; synovitis in early stage	Unknown; has anti-inflammatory effects caused by inhibition of cellular metabolism	6 mg po bid, increased to 9 mg after 6 months if response is inadequate	Diarrhea, pruritus, rash, alopecia, nausea, vomiting, conjunctivitis, proteinuria, anemia, leukopenia, eosinophilia, thrombocytopenia, stomatitis
Antihyperuricemics
Allopurinol (Zyloprim) Oral	Gout, excess uric acid, prevention of hyperuricemia associated with cancer chemotherapy	Suppresses formation of uric acid	100 mg po daily; take with meals and drink 10–12 glasses of fluid daily	Drowsiness, vomiting, rash, headache
Sulfinpyrazone (Anturane) Oral	Chronic and intermittent gouty arthritis	Blocks renal tubular reabsorption of uric acid and increases renal excretion of uric acid	100–200 mg po bid first week, then 200–400 mg po bid, maximum dose 800 mg, with meals or milk, individualized	Upper gastrointestinal disturbances, nausea, rash
Colchicine Oral, IV	Acute gout	Inhibits inflammatory response	Oral: 0.5–0.6 mg po daily, then 1 tab every hour until pain relief occurs or adverse gastrointestinal effects develop	Diarrhea, nausea, vomiting, bone marrow depression, neuritis, aplastic anemia
Muscle Relaxants
Carisoprodol (Soma) Oral	Acute, painful musculoskeletal conditions	Unknown; blocks interneuronal activity in descending reticular formation and spinal cord	350 mg qid	Drowsiness, dizziness, vertigo, skin rash, fever, tachycardia, nausea, hypotension, leukopenia, gastrointestinal upset
Methocarbamol (Robaxin) Oral, I V, IM	Acute, painful musculoskeletal conditions	Unknown; depresses central nervous system	Initial: 1500 mg qid; Maintenance: 1000 mg qid	Lightheadedness, dizziness, drowsiness, nausea, rash, pruritus, and other allergic manifestations; avoid alcohol
Baclofen (Lioresal) Oral	Muscle spasm	Reduces transmission of impulses from spinal cord to skeletal muscle	5 mg tid; increase dose slowly; do not exceed 80 mg/day; do not discontinue abruptly; give with meals to decrease GI distress	Drowsiness, confusion, dizziness, nausea, constipation; avoid alcohol
Bone Growth Regulators
Alendronate (Fosamax) Oral	Osteoporosis	Inhibits osteoclast activity, preventing bone resorption (Bisphosphonate)	5 mg daily or 35 mg once weekly	Flatulence, acid regurgitation, esophageal ulcer, dysphagia, symptomatic esophageal diseases, gastritis, duodenitis, ulcers
Ibandronate (Boniva) Oral	Osteoporosis	Inhibits osteoclast activity, preventing bone resorption (Bisphosphonate)	2.5 mg daily taken 60 minutes before any food or fluids except plain water; 150 mg taken once a month	Upper gastrointestinal disorders, dyspepsia, diarrhea, tooth disorder, vomiting, headache, myalgia
Antineoplastic Drug
Methotrexate Oral, IV	Severe rheumatoid arthritis	Binds with folic acid to inhibit synthesis of DNA and RNA	7.5 mg weekly, either as an initial single dose or as divided doses	Blood disorders, gastrointestinal bleeding, nausea, vomiting, liver toxicity

a Trade names given in parentheses are examples only. Check current drug references for a complete listing of available products.

b Average adult doses are given. However, dosages are determined by a physician and vary with the purpose of the therapy and the particular patient. The doses presented in this text are for general information only.