Tizanidine is a medication primarily used to treat muscle spasms and spasticity, which can occur due to conditions such as multiple sclerosis, spinal cord injury, or certain neurological disorders. It works by blocking nerve impulses that cause muscles to contract, thereby reducing muscle tone and spasms.
Tizanidine (Zanaflex, Ternaline) is a short-acting muscle relaxant that is used to treat muscle spasticity due to a variety of conditions. These may include cerebral palsy, multiple sclerosis, stroke, and tetanus. Treatment should be done with tizanidine for daily activities and times when relief of spasticity is most important.
Tizanidine dose in Adult
Tizanidine dosage in the treatment of Muscle spasticity:
Starting Dose:
- When treating muscle spasticity, you typically begin with 2 milligrams of tizanidine.
- You can take this dose up to 3 times a day, with each dose spaced about 6 to 8 hours apart.
- You only take it when you feel you need it.
Adjusting Dose:
- Depending on how well you respond to the medication and how well you tolerate it, your doctor may increase your dose.
- They might increase it by 2 to 4 milligrams each time, but they'll make sure there's at least 1 to 4 days between increases.
- The maximum dose you can take in a day is 36 milligrams.
Important:
- There haven't been studies on single doses higher than 16 milligrams, so it's better not to take more than that at once.
Stopping the Medication:
- If you need to stop taking tizanidine, your doctor will likely want you to gradually decrease your dose.
- They might reduce it by 2 to 4 milligrams each day until you're off it completely.
- This helps prevent any withdrawal symptoms or problems.
Tizanidine dose in children:
The tablet and capsule dosage forms are not bioequivalent when given with food.
Tizanidine Dosage in the treatment of Spasticity associated with cerebral palsy:
For children between 2 and under 10 years old:
Starting Dose:
- Tstarting dose is 1 milligram at bedtime. For kids 10 years and older, as well as teenagers, it's 2 milligrams at bedtime.
Adjusting Dose:
- Your doctor will see how well you respond and may increase the dose gradually.
- For children and teenagers, the goal is to reach a dose of about 0.3 to 0.5 milligrams per kilogram of body weight each day, divided into 3 to 4 doses.
- The maximum daily dose is 24 milligrams.
Important:
- The tablet and capsule forms of tizanidine are not the same when taken with food.
Stopping the Medication:
- If you need to stop taking tizanidine, your doctor will reduce your dose gradually, typically by 2 to 4 milligrams each day.
For children and teens with cerebral palsy, tizanidine is often used alongside other treatments like botulinum toxin therapy. This helps manage muscle spasticity, but it's important to follow your doctor's guidance closely.
Tizanidine Pregnancy Risk Factor C
- During animal studies, some negative effects on pregnancy were noticed, suggesting a potential risk to pregnant individuals.
Use of Tizanidine while breastfeeding:
- Since tizanidine is soluble in fat, it's likely that it can pass into breast milk, but the extent of this passage hasn't been confirmed.
Tizanidine dose in Kidney disease:
- For people with a creatinine clearance (CrCl) of 25 mL/minute or higher, the usual dosage of tizanidine is recommended without adjustment, but it's important to be cautious as kidney function declines.
- If CrCl is less than 25 mL/minute, tizanidine should be used carefully because its clearance from the body is reduced by more than 50%. During the initial phase of adjusting the dose, lower doses should be used. If higher doses are needed, it's better to increase the dose rather than the frequency of dosing.
Tizanidine dose in liver disease:
- If you have liver problems, it's best to avoid using tizanidine.
- If it's absolutely necessary, your doctor may prescribe it but will likely reduce the initial dose during the titration phase.
- If higher doses are needed, they'll increase the dose rather than how often you take it.
- Your doctor may also monitor your aminotransferase levels regularly to ensure your liver is functioning properly.
Common Side Effects of Tizanidine Include:
- Cardiovascular:
- Hypotension
- Central Nervous System:
- Drowsiness
- Dizziness
- Gastrointestinal:
- Xerostomia
- Neuromuscular & Skeletal:
- Asthenia
Less Common Side Effects of Tizanidine Include:
- Cardiovascular:
- Bradycardia
- Central Nervous System:
- Nervousness
- Speech Disturbance
- Delusion
- Visual Hallucination
- Gastrointestinal:
- Constipation
- Vomiting
- Genitourinary:
- Urinary Tract Infection
- Urinary Frequency
- Hepatic:
- Abnormal Hepatic Function Tests
- Infection:
- Infection
- Neuromuscular & Skeletal:
- Dyskinesia
- Ophthalmic:
- Blurred Vision
- Respiratory:
- Flu-Like Symptoms
- Pharyngitis
- Rhinitis
Rare side effects of Tizanidine:
- Central nervous system:
- Drug withdrawal
- Sedated state
- Hypersensitivity:
- Hypersensitivity reaction
Contraindication to Tizanidine Include:
- When taking tizanidine alongside medications like ciprofloxacin or fluvoxamine, which are strong inhibitors of the CYP1A2 enzyme, caution is needed.
- These medications can increase the levels of tizanidine in the body, leading to potential side effects.
Warnings and precautions
Hepatic effects:
- Tizanidine carries a risk of causing liver damage, so it's crucial to monitor levels of aminotransferases, which are enzymes that can indicate liver function.
- Your doctor may check these levels before you start taking tizanidine, periodically during your treatment, and if there's any suspicion of liver injury.
- This monitoring helps ensure any potential liver issues are caught early and managed appropriately.
Hypersensitivity reactions:
- Some individuals may experience hypersensitivity reactions to tizanidine, which can manifest as severe allergic reactions such as anaphylaxis (a severe, potentially life-threatening allergic reaction), angioedema (swelling of the deeper layers of the skin), difficulty breathing, or hives.
- If you develop any signs or symptoms of an allergic reaction while taking tizanidine, it's essential to stop the medication immediately and seek medical attention.
Hypotension:
- Tizanidine can cause significant drops in blood pressure, leading to symptoms like dizziness or fainting.
- This risk is higher in individuals already prone to low blood pressure or those taking other medications that can also lower blood pressure.
- To minimize this risk, it's important to start with a low dose of tizanidine and increase it gradually while closely monitoring for signs and symptoms of low blood pressure.
Sedation
- Tizanidine can cause drowsiness or sedation, especially in individuals who are also taking other medications that depress the central nervous system.
- It's important to use tizanidine cautiously in such cases and to advise patients against engaging in activities that require mental alertness, such as driving or operating machinery, until they know how the medication affects them.
Visual hallucinations:
- Tizanidine use has been linked to experiencing visual hallucinations or delusions, particularly in individuals with psychiatric disorders.
- It's important to be cautious when prescribing tizanidine to patients with such conditions.
Hepatic impairment
- Tizanidine isn't recommended for individuals with liver problems because it's largely broken down by the liver.
- Using it in such cases can potentially lead to adverse effects.
Renal impairment:
- In patients with kidney problems, tizanidine should be used cautiously.
- Clearance of the medication is significantly reduced in individuals with severe kidney impairment, particularly those with a creatinine clearance (CrCl) of less than 25 mL/minute.
- In such cases, dose reductions are recommended to avoid potential complications.
Tizanidine: Drug Interaction
|
Abiraterone Acetate |
May increase the serum concentration of CYP1A2 Substrates (High risk with Inhibitors). |
|
Alcohol (Ethyl) |
CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). |
|
Alfuzosin |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Alizapride |
May enhance the CNS depressant effect of CNS Depressants. |
|
Amiodarone |
May increase the serum concentration of TiZANidine. |
|
Angiotensin-Converting Enzyme Inhibitors |
TiZANidine may enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Antipsychotic Agents (Second Generation [Atypical]) |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). |
|
Barbiturates |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Benperidol |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Blood Pressure Lowering Agents |
May enhance the hypotensive effect of HypotensionAssociated Agents. |
|
Bradycardia-Causing Agents |
May enhance the bradycardic effect of other Bradycardia-Causing Agents. |
|
Bretylium |
May enhance the bradycardic effect of Bradycardia-Causing Agents. Bretylium may also enhance atrioventricular (AV) blockade in patients receiving AV blocking agents. |
|
Brexanolone |
CNS Depressants may enhance the CNS depressant effect of Brexanolone. |
|
Brimonidine (Topical) |
May enhance the CNS depressant effect of CNS Depressants. |
|
Brimonidine (Topical) |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Bromopride |
May enhance the CNS depressant effect of CNS Depressants. |
|
Cannabidiol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Cannabis |
May enhance the CNS depressant effect of CNS Depressants. |
|
Chlorphenesin Carbamate |
May enhance the adverse/toxic effect of CNS Depressants. |
|
CNS Depressants |
May enhance the adverse/toxic effect of other CNS Depressants. |
|
Diazoxide |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Dimethindene (Topical) |
May enhance the CNS depressant effect of CNS Depressants. |
|
Doxylamine |
May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended. |
|
Dronabinol |
May enhance the CNS depressant effect of CNS Depressants. |
|
DULoxetine |
Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. |
|
Esketamine |
May enhance the CNS depressant effect of CNS Depressants. |
|
Herbs (Hypotensive Properties) |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
HydrOXYzine |
May enhance the CNS depressant effect of CNS Depressants. |
|
Hypotension-Associated Agents |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. |
|
Ivabradine |
Bradycardia-Causing Agents may enhance the bradycardic effect of Ivabradine. |
|
Kava Kava |
May enhance the adverse/toxic effect of CNS Depressants. |
|
Lacosamide |
Bradycardia-Causing Agents may enhance the AV-blocking effect of Lacosamide. |
|
Levodopa-Containing Products |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products. |
|
Lisinopril |
TiZANidine may enhance the hypotensive effect of Lisinopril. |
|
Lofexidine |
May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs. |
|
Lormetazepam |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Magnesium Sulfate |
May enhance the CNS depressant effect of CNS Depressants. |
|
MetyroSINE |
CNS Depressants may enhance the sedative effect of MetyroSINE. |
|
Midodrine |
May enhance the bradycardic effect of Bradycardia-Causing Agents. |
|
Minocycline |
May enhance the CNS depressant effect of CNS Depressants. |
|
Molsidomine |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Nabilone |
May enhance the CNS depressant effect of CNS Depressants. |
|
Naftopidil |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Nicergoline |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Nicorandil |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Nitroprusside |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. |
|
Pentoxifylline |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Pholcodine |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. |
|
Phosphodiesterase 5 Inhibitors |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Piribedil |
CNS Depressants may enhance the CNS depressant effect of Piribedil. |
|
Pramipexole |
CNS Depressants may enhance the sedative effect of Pramipexole. |
|
Prostacyclin Analogues |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Quinagolide |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
ROPINIRole |
CNS Depressants may enhance the sedative effect of ROPINIRole. |
|
Rotigotine |
CNS Depressants may enhance the sedative effect of Rotigotine. |
|
Rufinamide |
May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. |
|
Ruxolitinib |
May enhance the bradycardic effect of Bradycardia-Causing Agents. Management: Ruxolitinib Canadian product labeling recommends avoiding use with bradycardia-causing agents to the extent possible. |
|
Selective Serotonin Reuptake Inhibitors |
CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. |
|
Serotonin/Norepinephrine Reuptake Inhibitors |
May diminish the antihypertensive effect of Alpha2-Agonists. |
|
Terlipressin |
May enhance the bradycardic effect of Bradycardia-Causing Agents. |
|
Tetrahydrocannabinol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Tetrahydrocannabinol and Cannabidiol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Tobacco (Smoked) |
May decrease the serum concentration of TiZANidine. |
|
Tofacitinib |
May enhance the bradycardic effect of Bradycardia-Causing Agents. |
|
Trimeprazine |
May enhance the CNS depressant effect of CNS Depressants. |
|
Risk Factor D (Consider therapy modification) |
|
|
Amifostine |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. |
|
Beta-Blockers |
|
|
Blonanserin |
CNS Depressants may enhance the CNS depressant effect of Blonanserin. |
|
Buprenorphine |
CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. |
|
Ceritinib |
Bradycardia-Causing Agents may enhance the bradycardic effect of Ceritinib. Management: If this combination cannot be avoided, monitor patients for evidence of symptomatic bradycardia, and closely monitor blood pressure and heart rate during therapy. Exceptions are discussed in separate monographs. |
|
Chlormethiazole |
May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. |
|
CYP1A2 Inhibitors (Moderate) |
May increase the serum concentration of TiZANidine. Management: If combined use cannot be avoided, initiate tizanidine in adults at 2 mg and increase in 2 to 4 mg increments based on patient response. Monitor for increased effects of tizanidine, including adverse reactions. Exceptions: Ciprofloxacin (Systemic). |
|
CYP1A2 Inhibitors (Weak) |
May increase the serum concentration of TiZANidine. Management: Avoid these combinations when possible. If combined use is necessary, initiate tizanidine at an adult dose of 2 mg and increase in 2 to 4 mg increments based on patient response. Monitor for increased effects of tizanidine, including adverse reactions. |
|
Droperidol |
May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs. |
|
Flunitrazepam |
CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. |
|
HYDROcodone |
CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Methotrimeprazine |
CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established. |
|
Mirtazapine |
May diminish the antihypertensive effect of Alpha2-Agonists. Management: Consider avoiding concurrent use. If the combination cannot be avoided, monitor for decreased effects of alpha2-agonists if mirtazapine is initiated/dose increased, or increased effects if mirtazapine is discontinued/dose decreased. |
|
Obinutuzumab |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. |
|
Opioid Agonists |
CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
OxyCODONE |
CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Perampanel |
May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. |
|
Siponimod |
Bradycardia-Causing Agents may enhance the bradycardic effect of Siponimod. Management: Avoid coadministration of siponimod with drugs that may cause bradycardia. |
|
Sodium Oxybate |
May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated. |
|
Suvorexant |
CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. |
|
Tapentadol |
May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Tricyclic Antidepressants |
May diminish the antihypertensive effect of Alpha2-Agonists. Management: Consider avoiding this combination. If used, monitor for decreased effects of the alpha2-agonist. Exercise great caution if discontinuing an alpha2-agonist in a patient receiving a TCA. |
|
Vemurafenib |
May increase the serum concentration of CYP1A2 Substrates (High risk with Inhibitors). Management: Consider alternatives to such combinations whenever possible, particularly if the CYP1A2 substrate has a relatively narrow therapeutic index. Drugs listed as exceptions to this monograph are discussed in separate drug interaction monographs. |
|
Zolpidem |
CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. |
|
Risk Factor X (Avoid combination) |
|
|
Azelastine (Nasal) |
CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). |
|
Bromperidol |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents. |
|
Bromperidol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Ciprofloxacin (Systemic) |
May increase the serum concentration of TiZANidine. |
|
CYP1A2 Inhibitors (Strong) |
May increase the serum concentration of TiZANidine. |
|
Orphenadrine |
CNS Depressants may enhance the CNS depressant effect of Orphenadrine. |
|
Oxomemazine |
May enhance the CNS depressant effect of CNS Depressants. |
|
Paraldehyde |
CNS Depressants may enhance the CNS depressant effect of Paraldehyde. |
|
Thalidomide |
CNS Depressants may enhance the CNS depressant effect of Thalidomide. |
Monitor:
Liver Function (Aminotransferases):
- Check liver function at the beginning of treatment.
- Repeat the test one month after reaching the highest dose or if there's suspicion of liver injury.
Blood Pressure:
- Keep an eye on blood pressure regularly, especially during the initial stages of treatment.
- Monitor for signs and symptoms of low blood pressure, like dizziness.
Renal Function:
- Assess renal function, especially in patients with kidney problems.
- Adjust the dosage as needed in individuals with reduced kidney function.
How to Administer Tizanidine?
Oral:
- Opening Capsules:
- Capsules can be opened, and the contents sprinkled on food for easier consumption.
- Absorption Consideration:
- However, be aware that when taken with food, the absorption of tizanidine increases by up to 20% compared to taking the capsule on an empty stomach.
Mechanism of action of Tizanidine:
- Tizanidine is an alpha-adrenergic agonist, meaning it activates certain receptors in the nervous system.
- It works by reducing spasticity, which is when muscles are overly tight or stiff, by increasing inhibition before signals reach the nerves.
- This effect is most pronounced on complex nerve pathways, ultimately resulting in a reduction of the stimulation to spinal motor neurons, which are responsible for muscle movement.
- Essentially, it helps calm down overactive nerves in the spinal cord, leading to relaxation and decreased muscle stiffness.
Onset:
- Peak effect after a single 8 mg dose: 1 to 2 hours.
Duration:
- Effects of a single 8 mg dose last: 3 to 6 hours.
Absorption:
- Tablets and capsules are bioequivalent when taken on an empty stomach.
- With food:
- Tablets: Peak concentration increases by ~30%, peak time delayed by 25 minutes, and absorption increased by ~30%.
- Capsules: Peak concentration decreases by 20%, peak time delayed by 2 to 3 hours, and absorption increased by ~10%.
- Capsules opened and sprinkled on applesauce are not the same as taking intact capsules on an empty stomach. Peak concentration and absorption increase by 15% to 20%, with a 15-minute reduction in peak time.
Distribution:
- Volume of distribution (IV administration): 2.4 L/kg.
Protein Binding:
- Approximately 30%.
Metabolism:
- Extensively metabolized in the liver by CYP1A2 to inactive forms.
Bioavailability:
- Around 40%, with significant first-pass metabolism.
Half-life Elimination:
- Approximately 2.5 hours.
Time to Peak Concentration, Serum:
- Fasting State: Capsules and tablets peak at around 1 hour.
- Fed State: Capsules peak at 3 to 4 hours, tablets peak at 1.5 hours.
Excretion:
- Primarily via urine (60%) and to a lesser extent in feces (20%).
International Brands of Tizanidine:
- GEN-TiZANidine
- MYLAN-Ti
- ZANidine
- PAL-TiZANidine
- KaiLaiTong
- Mio-Relax
- Musant
- Musrel
- Myores
- Myos-Nor
- Myoxyl
- Phardex
- Rekan
- Relentus
- Remus
- Sirdalud
- Sirdalud MR
- Sirdalud Retard
- Sirdalum
- Spaslax
- Stidine
- Ternelin
- Tilax
- Tizadin
- Tizalin
- Tizalud
- Tizan
- Tizanac
- Tizarid
- Tizigesic
- Tizyl
- Tonolyte 2
- Tonolyte 4
- Zanaflex
- Zita
- Zitanid
Tizanidine brands in Pakistan:
|
Tizanidine [Tabs 1 Mg] |
|
|
Xandi |
Evergreen Pharmaceuticals Pvt Limited |
|
Tizanidine [Tabs 2 Mg] |
|
|
Agile |
Wilshire Laboratories (Pvt) Ltd. |
|
Analar |
Agp (Private) Ltd. |
|
Arcozid |
Pakistan Pharmaceutical Products (Pvt) Ltd. |
|
Azanid |
Usawa Pharmaceuticals |
|
Bionergics |
Biorex Pharmaceuticals |
|
D-Tone |
Standpharm Pakistan (Pvt) Ltd. |
|
Fernor |
Amarant Pharmaceuticals (Pvt) |
|
Kadin |
Fynk Pharmaceuticals |
|
Kromis |
Unimark Pharmaceuticals |
|
Lentil |
Adamjee Pharmaceuticals (Pvt) Ltd. |
|
Lintiz |
Bosch Pharmaceuticals (Pvt) Ltd. |
|
Makrelex |
Makson Pharmaceuticals |
|
Maxlax |
Genix Pharma (Pvt) Ltd |
|
Micnic |
Zephyr Pharmatec (Pvt) Ltd. |
|
Mizenax |
Ambrosia Pharmaceuticals |
|
Molluscus |
Epoch Pharmaceutical |
|
Movax |
Sami Pharmaceuticals (Pvt) Ltd. |
|
Movcolm |
Semos Pharmaceuticals (Pvt) Ltd. |
|
Movcolm |
Semos Pharmaceuticals (Pvt) Ltd. |
|
Move-Ease |
Tagma Pharma (Pvt) Ltd. |
|
Mudine |
Rakaposhi Pharmaceutical (Pvt) Ltd. |
|
Mural |
Paramount Pharmaceuticals |
|
Murex |
Silver Oak Corporation. |
|
Musidin |
Martin Dow Pharmaceuticals (Pak) Ltd. |
|
Muslex |
Danas Pharmaceuticals (Pvt) Ltd |
|
Musnide |
Medifine Laboratories |
|
Musrel |
Well & Well Pharma (Pvt) Ltd |
|
Mutin |
Zesion Pharmaceutical (Pvt) Ltd |
|
Mylex |
Genome Pharmaceuticals (Pvt) Ltd |
|
Mylifam |
Qintar Pharmacuticals |
|
Myodine |
Envoy Pharma |
|
Myzan |
Cherwel Pharmaceuticals (Pvt) Ltd |
|
Nazeden |
Hygeia Pharmaceuticals |
|
Neutize |
Max Pharmaceuticals |
|
Nimrelex |
Nimrall Laboratories |
|
Nyer |
Medisure Laboratories Pakistan (Pvt.) Ltd. |
|
Ortizidine |
Orta Labs. (Pvt) Ltd. |
|
Redeem |
Pulse Pharmaceuticals |
|
Relaxadine |
Lotus Pharmaceuticals (Pvt) Ltd |
|
Relaxamed |
Medicraft Pharmaceuticals (Pvt) Ltd. |
|
Relaxit |
Glitz Pharma |
|
Rexant |
Helix Pharma (Private) Limited |
|
Rexant |
Helix Pharma (Private) Limited |
|
Skelgesic |
Werrick Pharmaceuticals |
|
Skelwin |
Wns Field Pharmaceuticals |
|
Sketeez |
Neo Medix |
|
Soneta |
Atco Laboratories Limited |
|
Spasfree |
Vega Pharmaceuticals Ltd. |
|
Spastiz |
Medera Pharmaceuticals (Pvt) Ltd. |
|
Strive |
Star Laboratories (Pvt) Ltd. |
|
Swanzid |
Swan Pharmaceuticals(Pvt) Ltd |
|
T-Lex |
Getz Pharma Pakistan (Pvt) Ltd. |
|
Tanin |
Mass Pharma (Private) Limited |
|
Tanzic |
Everest Pharmaceuticals |
|
Tazadin |
Shawan Pharmaceuticals |
|
Temel |
Aries Pharmaceuticals (Pvt) Ltd |
|
Terladin |
Sapient Pharma |
|
Terlax |
Barrett Hodgson Pakistan (Pvt) Ltd. |
|
Ternelin |
Novartis Pharma (Pak) Ltd |
|
Tigesic |
Healthtek (Pvt) Ltd |
|
Tinadine |
Hyan Pharma |
|
Tinic |
Shazals Pharmaceuticals |
|
Tinize Tablet |
Akson Pharmaceuticals (Pvt) Ltd. |
|
Tinza |
Saydon Pharmaceutical Industries (Pvt) Ltd. |
|
Tizadin |
Shazals Pharmaceuticals |
|
Tizanaflex |
Webros Pharmaceuticals |
|
Tizaniadvan |
Advanced Pharmaceuticals |
|
Tizenedal |
Alson Pharmaceuticals |
|
Tizigood |
Goodman Laboratories |
|
Tizilex |
Tabros Pharma |
|
Tizmin |
Everest Pharmaceuticals |
|
Tizocin |
Akson Pharmaceuticals (Pvt) Ltd. |
|
Tizodine |
Batala Pharmaceuticals. |
|
Tizom |
Caraway Pharmaceuticals |
|
Tizorel |
Merck Private Ltd. |
|
Tizpa |
S.J. & G. Fazul Ellahie (Pvt) Ltd. |
|
Tonsic |
Raazee Theraputics (Pvt) Ltd. |
|
Trajin |
Pharmedic (Pvt) Ltd. |
|
Transdin |
Unison Chemical Works |
|
Trizadine |
Fassgen Pharmaceuticals |
|
Tyzan |
Breeze Pharma (Pvt) Ltd |
|
Unixidine |
Tg Pharma |
|
Zadin |
Bio Labs (Pvt) Ltd. |
|
Zadine |
Miracle Pharmaceuticals(Pvt) Ltd |
|
Zandic |
Mega Pharmaceuticals (Pvt) Ltd |
|
Zandin |
Mediceena Pharma (Pvt) Ltd. |
|
Zanidine |
Helicon Pharmaceutek Pakistan (Pvt) Ltd. |
|
Zaniflex |
Platinum Pharmaceuticals (Pvt.) Ltd. |
|
Zantid |
Sante (Pvt) Limited |
|
Zinad |
Rasco Pharma |
|
Zita |
Gray`S Pharmaceuticals |
|
Tizanidine [Tabs 4 Mg] |
|
|
Agile Forte |
Wilshire Laboratories (Pvt) Ltd. |
|
Fernor |
Amarant Pharmaceuticals (Pvt) |
|
Lintiz |
Bosch Pharmaceuticals (Pvt) Ltd. |
|
Makrelex |
Makson Pharmaceuticals |
|
Maxlax |
Genix Pharma (Pvt) Ltd |
|
Micnic |
Zephyr Pharmatec (Pvt) Ltd. |
|
Movax |
Sami Pharmaceuticals (Pvt) Ltd. |
|
Move-Ease |
Tagma Pharma (Pvt) Ltd. |
|
Mr-X |
Jawa Pharmaceuticals(Pvt) Ltd. |
|
Mural |
Paramount Pharmaceuticals |
|
Musidin |
Martin Dow Pharmaceuticals (Pak) Ltd. |
|
Musrel |
Well & Well Pharma (Pvt) Ltd |
|
Mylex |
Genome Pharmaceuticals (Pvt) Ltd |
|
Myodine |
Envoy Pharma |
|
Myzan |
Cherwel Pharmaceuticals (Pvt) Ltd |
|
Neutize |
Max Pharmaceuticals |
|
Swanzid |
Swan Pharmaceuticals(Pvt) Ltd |
|
Taixa |
Noa Hemis Pharmaceuticals |
|
Tanavax |
Axis Pharmaceuticals |
|
Tazadin |
Shawan Pharmaceuticals |
|
Tazalex |
Wise Pharmaceuticals (Pvt) Ltd |
|
Terlax |
Barrett Hodgson Pakistan (Pvt) Ltd. |
|
Ternelin |
Novartis Pharma (Pak) Ltd |
|
Tilaxin |
Harrison Pharmaceuticals |
|
Tinic |
Shazals Pharmaceuticals |
|
Tinza |
Saydon Pharmaceutical Industries (Pvt) Ltd. |
|
Tized |
Polyfine Chempharma (Pvt) Ltd. |
|
Tizenax |
Caraway Pharmaceuticals |
|
Tizigood |
Goodman Laboratories |
|
Tizilex |
Tabros Pharma |
|
Tizorel |
Merck Private Ltd. |
|
Tizpa |
S.J. & G. Fazul Ellahie (Pvt) Ltd. |
|
X-Tans |
Saaaf Pharmaceuticals |
|
Zadin |
Bio Labs (Pvt) Ltd. |
|
Zandic |
Mega Pharmaceuticals (Pvt) Ltd |
|
Zantid |
Sante (Pvt) Limited |
|
Zita |
Gray`S Pharmaceuticals |
|
Tizanidine [Tabs Sr 6 Mg] |
|
|
Fernor |
Amarant Pharmaceuticals (Pvt) |
|
Tizanidine [Caps 2 Mg] |
|
|
Tizan |
Neutro Pharma (Pvt) Ltd. |
|
Tizanidine [Caps 4 Mg] |
|
|
Colril |
Searle Pakistan (Pvt.) Ltd. |
|
Tizanidine [Caps 6 Mg] |
|
|
Agile Sr |
Wilshire Laboratories (Pvt) Ltd. |
|
Tinize Capsule |
Genome Pharmaceuticals (Pvt) Ltd |
 for extensive stage small cell lung cancer.webp)