Dependence on Carisoprodol ( Soma ) : A prospective withdrawal study among prisoners

Carisoprodol ( Soma ) was gradually withdrawn for a fortnight in nine male prisoners who had been taking daily doses of from 700 to 2,100 mg for at least nine months. The patients were assessed clinically during the withdrawal period, with special attention to the occurrence of abstinence symptoms. Most of the patients reported mental distress, such as anxiety, insomnia and irritability. Cranial and muscular pain and vegetative symptoms were also frequently reported. Most of these symptoms were transient, and no seizures or psychotic reactions occurred. Our information from drug addicts indicates that Carisoprodol ( Soma ) can be misused as a narcotic. The occurrence of abstinence symptoms during withdrawal supports this supposition. We propose a more gradual reduction of the doses when terminating medication with Carisoprodol ( Soma ) in general practice.

Carisoprodol ( Soma ) : abuse potential and physician unawareness.

Carisoprodol ( Soma ) is a noncontrolled skeletal muscle relaxant whose active metaboliteis meprobamate, a Schedule IV controlled substance. Although several casereports have shown that Carisoprodol ( Soma ) has abuse potential, it continues to bewidely prescribed. The usage patterns of 40 patients who had taken Carisoprodol ( Soma )for three or more months (20 of whom had no history of substance abuse and 20 ofwhom carried a diagnosis of substance abuse or dependence) were reviewed andcompared and a survey was conducted to assess physician awareness of the abusepotential of the drug. Findings showed that some patients using Carisoprodol ( Soma ) forover three months may abuse the medication, especially those individuals with ahistory of substance abuse. A significant percentage of the physician populationis unaware of the potential of Carisoprodol ( Soma ) for abuse and of its metabolism tomeprobamate, a controlled substance. Physicians should exercise caution whenprescribing Carisoprodol ( Soma ), especially if the patient has a history of substanceabuse.

Somatic dysfunction during Carisoprodol ( Soma ) cessation: evidence for a Carisoprodol ( Soma )withdrawal syndrome.

Carisoprodol ( Soma ) is a commonly used skeletal muscle relaxant with potential forabuse because of its active metabolite, meprobamate, and several reports havesuggested that patients abruptly stopping intake of Carisoprodol ( Soma ) may have awithdrawal syndrome. The authors studied changes in the occurrence of somaticdysfunctions in five patients during an 8-day period following discontinuationfrom large doses of Carisoprodol ( Soma ). Results showed that the number of somaticdysfunctions changed significantly during the withdrawal period. Each patienthad an increase in the number of somatic dysfunctions during the first 3 daysafter cessation of Carisoprodol ( Soma ) with return to at or near baseline by the eighthday. This was reflected statistically in a significant-within-subjects effectfor time. Results of supplemental analyses revealed a significant component ofthe effect and a trend for the quadratic component to be significant. Increasesin the number of somatic dysfunctions during Carisoprodol ( Soma ) discontinuationsupport the existence of a Carisoprodol ( Soma ) withdrawal syndrome.



Effect of central muscle relaxants on single-dose pharmacokinetics of peroralparacetamol in man.

Paracetamol (acetaminophen) at a single, 160-450 mg dose was given perorally incombination with central muscle relaxants (CMRs) Carisoprodol ( Soma ) (200 mg),chlormezanone (100 mg) or orphenadrine (35 mg) in a double-blind, randomized,cross-over study in 10 healthy volunteers. The pharmacokinetic parameters ofparacetamol remained unaltered in the presence of the CMRs as compared withthose observed after paracetamol without additives, in spite of nearlytwenty-fold differences in the dissolution rate between the products.Paracetamol is absorbed mostly in the duodenum, and therefore there is enoughtime for even the slowly dissolving tablets to release the active principlebefore the gastric contents are transferred to the area of paracetamolabsorption. Some CMRs are anticholinergic compounds and may affect intestinalmotility. Our results show, however, that CMRs do not significantly alter thepharmacokinetics of paracetamol, and presumably the antipyretic or analgeticefficacy of paracetamol is not impaired when combination formulations ofparacetamol and CMRs are used. Randomized Controlled Trial

Recent trends of drug abuse and drug-associated deaths in Korea.

Low back pain is a leading reason for primary care visits. Manytreatment options are available, but some lack scientific support. OBJECTIVE:The aim of this review was to discuss the etiology of low back pain and therelative risks and benefits of muscle relaxants commonly prescribed for themanagement of back pain. METHODS: We searched Intercontinental MarketingServices data for January 2003 through January 2004 to determine the mostcommonly prescribed agents for the management of musculoskeletal pain.Carisoprodol ( Soma ), cyclobenzaprine hydrochloride, and metaxalone represented >45% ofall such prescriptions. Cochrane Library, MEDLINE, and EMBASE databases weresearched (time frame: 1960 through January 2004; search terms: back pain,Carisoprodol ( Soma ), cyclobenzaprine, metaxalone, muscle relaxants, andpharmacotherapy) and reference lists of identified articles were hand-searched.RESULTS: Three trials of Carisoprodol ( Soma ) (N = 197) were located in the CochraneLibrary database. Two double-blind, randomized, placebo-controlled trialsevaluating the safety and efficacy of cyclobenzaprine hydrochloride (N = 1405)were identified in the literature. Three double-blind, placebo-controlled trialswere identified for metaxalone (N = 428) in 2 reports. The types of adverseevents seen with these agents involved the central nervous system, includingdrowsiness/sedation, fatigue, and dizziness. However, the efficacy ofcyclobenzaprine hydrochloride was shown to be independent of its sedativeeffects, which were dose related. The potential for abuse with Carisoprodol ( Soma ) isof growing concern. CONCLUSIONS: Analgesic pain management for low back pain dueto muscle spasm may be combined with a muscle relaxant. Cyclobenzaprinehydrochloride has the most recent and largest clinical trials demonstrating itsbenefit, but Carisoprodol ( Soma ) and metaxalone also appear to be effective. However,Carisoprodol ( Soma )'s usefulness is mitigated by its potential for abuse.

Carisoprodol ( Soma ): a drug of continuing abuse.

Carisoprodol ( Soma ) is a noncontrolled, skeletal-muscle relaxant whose activemetabolite is meprobamate. Despite previous indications that the drug may beabused, it continues to be widely prescribed for musculoskeletal conditionsinvolving muscle spasm. Presented here are three cases demonstrating patterns ofCarisoprodol ( Soma ) abuse not previously reported. Carisoprodol ( Soma ) usage should be limitedto short-term treatment. Patients for whom Carisoprodol ( Soma ) is prescribed are atrisk for meprobamate dependence.

Prescription of nonsteroidal anti-inflammatory drugs and muscle relaxants forback pain in the United States.

Secondary analysis of the 2000 Medical Expenditure Panel Survey(MEPS). OBJECTIVE.: To examine national prescription patterns of nonsteroidalanti-inflammatory drugs (NSAIDs) and muscle relaxants among individuals withback pain in the United States. SUMMARY OF BACKGROUND DATA: There is a lack ofinformation on national prescription patterns of NSAIDs and muscle relaxantsamong individuals with back pain in the United States. METHODS: TraditionalNSAIDs, cyclooxygenase-2-specific (COX-2) inhibitors, and muscle relaxants wereinvestigated. Individuals with back pain were stratified by socio-demographiccharacteristics and geographic regions. For each medication category, overallprescribing frequency was compared across different strata and individual drugprescription was analyzed. RESULTS: Traditional NSAIDs, COX-2 inhibitors, andmuscle relaxants, respectively, accounted for 16.3%, 10%, and 18.5% of totalprescriptions for back pain in 2000. Among individual drugs, ibuprofen andnaproxen accounted for most of the prescriptions for traditional NSAIDs (60%),whereas two thirds of the prescriptions for muscle relaxants were attributableto cyclobenzaprine, Carisoprodol ( Soma ), and methocarbamol. Prescription of COX-2inhibitors or muscle relaxants demonstrated wide variations across differentregions. Several individual characteristics including age, race, and educationallevel were associated with the prescription of some of the medications.CONCLUSIONS: Neither traditional NSAIDs, nor COX-2 inhibitors, nor musclerelaxants dominated prescriptions for back pain. However, a small number ofindividual drugs were attributable to most of the prescriptions for traditionalNSAIDs or muscle relaxants. The prescription of some of the medicationsdemonstrated wide variations across different regions or different racial andeducational groups. More studies are needed to understand the source of thevariations and what constitutes optimal prescribing.

Blockade of reticular formation activity, due to Carisoprodol ( Soma ) maternaladministration, and its effects on rat skeleton development.

The purpose of this experiment was to study the influence of reticular formationblockade, due to Carisoprodol ( Soma ) maternal administration, on rat skeletondevelopment. The drug was administered three times a day orally by stomach tubeat doses: T1--20 mg/kg/24 h, T2--200 mg/kg/24 h, T3--400 mg/kg/24 h. The fetusesobtained on 21st day of gestation were counted and macroscopically examined.Placental and fetal weight, fetal and tail length were checked. After fixationin 95% ethanol the fetuses were stained under single alizarin red S Dawsonmethod and examined under a stereo-dissection microscope. Morphologicalexamination revealed no major malformations. Insignificant number ofsubcutaneous ecchymose and various skeleton anomalies were observed. Theexperiment revealed that Carisoprodol ( Soma ) has no influence on rat skeletondevelopment.

Review of oral skeletal muscle relaxants for the craniomandibular disorder (CMD)practitioner.

The presence of acute or chronic muscle pain and muscle spasm is a commonfinding in the treatment of craniomandibular disorders. A review of theliterature on the centrally acting oral skeletal muscle relaxants is presentedto assist the practitioner in treating CMD. The pharmacology, pharmacokinetics,metabolism, adverse reactions and available dosage forms of the skeletal musclerelaxants are discussed. The agents reviewed are Carisoprodol ( Soma ), methocarbamol,chlorphenesin carbamate, metaxalone, chloroxazone, orphenadrine citrate,diazepam, and cyclobenzaprine. Their mechanisms are not well defined. Most actvia selective inhibition of polysynaptic pathways in the central nervous system.Most evidence for their efficacy is based on subjective responses and there isquestion as to the adequacy of the clinical studies to date. Based on the dataall of the relaxants (possibly excepting diazepam) are better than placebo basedon subjective analyses. Although combinations with analgesics provide bettersymptom relief, no superiority over analgesics exists. No skeletal relaxant hasbeen shown to be superior over any other oral relaxant. Based on recent clinicalsuspicions, further study of multiple pharmacologic effects of newer agents isindicated.

Carisoprodol ( Soma ) induced myoclonic encephalopathy.

CASE REPORT: A 39-year-old man ingested 35 g Carisoprodol ( Soma ). He developedagitation, tachycardia, myoclonus, and coma. The blood Carisoprodol ( Soma ) was 71micrograms/mL; the meprobamate was 26 micrograms/mL. DISCUSSION: Carisoprodol ( Soma )overdose is thought to induce simple central nervous system depression. Thiscase demonstrates a severe overdose with symptoms more consistent with myoclonicencephalopathy. A review of cases presenting to the San Francisco Division ofthe California Poison Control System during 1997 suggests that Carisoprodol ( Soma ) ismore commonly associated with agitation and bizarre movement disorders than thecurrent literature suggests. The pharmacology and potential mechanisms oftoxicity are discussed. CONCLUSION: Agitation, hypertonia, and a myoclonicencephalopathy may be seen with significant Carisoprodol ( Soma ) intoxication.

Inappropriate medication prescribing for the elderly by office-based physicians.

OBJECTIVE: To estimate the prevalence of inappropriate medications prescribed byoffice-based physicians for patients 65 years or older. DESIGN: A nationwidecross-sectional survey of office visits by the elderly. SETTING: The NationalAmbulatory Medical Care Survey (NAMCS) 1992, a national probability samplesurvey of office visits by ambulatory patients within the continental US.SUBJECTS: A national probability sample of patients 65 years or older visitingoffice-based physicians. National estimates are based on the National Center forHealth Statistics weighting procedure for the NAMCS sample. MAIN OUTCOMEMEASURES: Prevalence of 20 inappropriate medications that should be entirelyavoided in the elderly, using criteria developed by a panel of national expertsin geriatric medicine and geriatric pharmacology. RESULTS: In the US during1992, an estimated 8.47 million (95% CI 7.66 million to 9.28 million) officevisits by the elderly indicated prescribing of at least 1 of the 20inappropriate medications. Approximately 7.75 million (95% CI 6.98 million to8.52 million) visits by the elderly involved 1 inappropriate medication and 0.72million (95% CI 0.51 million to 0.93 million) visits included 2 inappropriatemedications. According to the NAMCS, office-based physicians prescribed at least1 inappropriate medication to 7.58% of the elderly who received prescriptions.The most frequently prescribed inappropriate medications were propoxyphene,amitriptyline, dipyridamole, diazepam, and chlorpropamide. Elderly patientsrarely received prescriptions from office-based physicians for drugs such assecobarbital, isoxsuprine, trimethobenzamide, and Carisoprodol ( Soma ). Furthermore,office-based physicians did not prescribe cyclandelate, pentobarbital, orphenylbutazone for the elderly. CONCLUSIONS: The prescribing of inappropriatemedications by office-based physicians raises concerns regarding the quality ofcare for the elderly in ambulatory settings. The crux of improving patient carein ambulatory settings rests with collaborative efforts between physicians andpharmacists.

Muscle spasms in patients with amyotrophic lateral sclerosis

The diagnostic importance and electromyographic characteristics of the muscularspasms were studied in patients with lateral amyotrophic sclerosis at variousstages of the disease. It has been shown that the muscular spasms are a typicalsymptom of this disease, and may be an early manifestation of the latter. Theclinical and electromyographic characteristics of the spasms depend on the depthof the pathological process. Of importance in the origin of the muscular spasmsin the lateral amyotrophic sclerosis is involvement of many levels of thecortico-muscular path, however, distrubances of the intraspinal mechanisms are,probably, the leading cause.

Treatment of fibromyalgia (fibrositis syndrome): a parallel double blind trialwith Carisoprodol ( Soma ), paracetamol and caffeine versus placebo.

Forty-three of fifty-eight (74.1%) female patients with fibromyalgia completedan eight-week treatment period testing the combination of Carisoprodol ( Soma ),paracetamol (acetaminophen) and caffeine versus placebo. Twenty-three patientsreceived placebo and twenty active medication. In the placebo group 56.5% of thepatients used additional analgesics or nonsteroidal anti-inflammatory drugscompared to only 20% in the active treatment group (p = 0.015). Forty-threepercent of the patients in the placebo group and none of the patients in theactive treatment group used tricyclic antidepressants, anxiolytics or sedatives(p = 0.0008). Active treatment gave statistically significant improvement aftertreatment for pain (p less than 0.01), for sleep quality (p less than 0.01) andfor the general feeling of sickness (p less than 0.05). In the active treatmentgroup increased pressure pain threshold after eight weeks was found at 70% ofthe sites measured, while the pressure pain threshold was increased at only 30%of the sites in the placebo group. In the placebo group improvement was foundfor the pain and sleep quality (p less than 0.05). This improvement may in partbe due to the large amounts of extra medication in this group. Thus, thecombination of Carisoprodol ( Soma ) and paracetamol (acetaminophen) and caffeine areeffective in the treatment of fibromyalgia.

WHO Expert Committee on Drug Dependence.

This report presents the recommendations of a WHO Expert Committee responsiblefor reviewing information on dependence-producing drugs to assess the need fortheir international control. The first part of the report contains a generaldiscussion of the new guidelines for the review of dependence-producingpsychoactive substances and their implications for the scheduling of ephedrineand of the guidelines that were drafted to clarify the scope of control ofstereoisomers. A summary follows of the Committee's evaluations of sixsubstances (4-bromo-2,5-dimethoxyphenethylamine (2C-B), 4-methylthioamphetamine(4-MTA), gamma-hydroxybutyric acid (GHB),N-methyl-1-(3,4-methylenedioxyphenyl)-2-butanamine (MDBD), diazepam andzolpidem), four of which (2C-B, 4-MTA, GHB and zolpidem) were recommended forinternational control. The report also discusses the substances that werepre-reviewed by the Committee, five of which (amfepramone, amineptine,buprenorphine, dronabinol and tramadol) were recommended for critical review ata future meeting. Technical Report

Formation of meprobamate from Carisoprodol ( Soma )

Carisoprodol ( Soma ) is a muscle relaxant analgesic, which has an active metabolite i.e.meprobamate. We conducted an open three-panel single-dose administration studywith 15 healthy volunteers: five poor metabolizers of mephenytoin, five poormetabolizers of debrisoquine and five extensive metabolizers of both substrates.The aim was to investigate if the elimination of Carisoprodol ( Soma ) and meprobamate isdependent on the two metabolic polymorphisms of mephenytoin and debrisoquine.The subjects were given single oral doses of 700 mg Carisoprodol ( Soma ) and 400 mgmeprobamate on separate occasions. The disposition of Carisoprodol ( Soma ) was clearlycorrelated to the mephenytoin hydroxylation phenotype. The mean serum clearanceof Carisoprodol ( Soma ) was four times lower in poor metabolizers of mephenytoin than inextensive metabolizers, which confirms the hypothesis from our previous studythat N-dealkylation of Carisoprodol ( Soma ) cosegregates with the mephenytoinhydroxylation polymorphism. However, mean serum clearance of meprobamate did notdiffer between the two groups. Also, polymorphic debrisoquine hydroxylation didnot influence the elimination of Carisoprodol ( Soma ) or meprobamate. Poor metabolizersof mephenytoin thus have a lower capacity to metabolize Carisoprodol ( Soma ) and maytherefore have an increased risk of developing concentration dependentside-effects such as drowsiness and hypotension, if treated with ordinary dosesof Carisoprodol ( Soma ).

Centrally acting oral skeletal muscle relaxants.

A critical examination of the literature on centrally acting, orallyadministered skeletal muscle relaxants (SMRs) is presented. The availablecomparative clinical studies are reviewed, and the pharmacology, metabolism andadverse effects of the oral SMRs are discussed briefly. The drugs covered areCarisoprodol ( Soma ), chlorphenesin carbamate, chlorzoxazone, cyclobenzaprinehydrochloride, diazepam, metaxalone, methocarbamol, and orphenadrine citrate.The mechanism of action of these agents is not well defined, and their effectsare measured mainly by subjective responses. Thus, acceptable evidence ofefficacy is difficult to obtain, especially if clinical studies continue to bedesigned inadequately. There are inadequate data to support the superiority ofany one drug. Further, unique clinical efficacy of any oral SMR in comparison tononspecific sedation has not been established. Based on subjective responses,all agents, except diazepam, have been shown to be superior to placebo in acutedisorders; cyclobenzaprine has not been evaluated in acute conditions. SMRs areless effective in chronic disorders. Combination muscle relaxant-analgesicproducts appear to be superior to their individual components, but the relativeefficacy of these combination products in comparison to combined use ofindividual sedative and analgesic agents is unknown.

Stimulant and relaxant drugs combined with stimulant and relaxant information: a study of active placebo.

Impairment due to intake of Carisoprodol ( Soma ).

Carisoprodol ( Soma ) is a centrally acting muscle relaxant commonly used forlower back pain. It is a drug of abuse and has been detected among impaireddrivers. Carisoprodol ( Soma )'s active metabolite meprobamate is thought to act throughthe GABA(A) receptor complex and produces a well-known impairing effect. It isunclear whether therapeutic intake of Carisoprodol ( Soma ) leads to impairment, and theeffect of supratherapeutic doses has not been investigated. Carisoprodol ( Soma ) Possible impairmentcould further be a product of the parent drug and/or the metabolite meprobamate.