Should you mix muscle relaxants with alcohol?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Feb 29, 2024.

Alcohol should be avoided if you are under treatment with a centrally-acting muscle relaxant (like cyclobenzaprine, baclofen, methocarbamol or tizanidine). When muscle relaxants are combined with alcohol (ethanol), side effects such as drowsiness, confusion, dizziness, and errors in judgement can occur. Driving or other hazardous activities may be more dangerous and should be avoided.

Skeletal muscle relaxants (see Table 1) work primarily in the spinal cord and brain, also called the central nervous system, to block pain sensations between the nerves and the brain. They relieve painful muscle spasms and spasticity due to conditions like acute back pain or multiple sclerosis.

What are muscle relaxants?

Muscle relaxants are a varied group of medications commonly used to treat several conditions associated with muscle spasms, including:

Spasticity (painful stiff and rigid muscles) from upper motor neuron syndromes such as cerebral palsy, multiple sclerosis, traumatic brain injury, or stroke. Baclofen and dantrolene are often used.
Muscle spasms and tension from painful muscle conditions that are usually short-lived and linked with conditions like acute injury, back pain, tension headaches, or fibromyalgia. Metaxalone, cyclobenzaprine, and methocarbamol may be prescribed.
The botulinum toxins (Botox, Dysport, Myobloc, Xeomin, Daxxify) and dantrolene work directly on muscle fibers in the peripheral nervous system. The botulinum toxins are not reported to have an interaction with alcohol, but dantrolene can cause CNS depression (drowsiness, dizziness) and use with alcohol should be avoided.
Botulinum toxin (Botox) is FDA approved to treat spasticity in certain muscle groups of the upper and lower limbs and eyelids. Botox is also used for cervical dystonia, when the neck muscles involuntarily contract causing your head to uncontrollably tilt forward or backward.
Some botulinum toxins, like Botox Cosmetic and Jeuveau, are approved only to lessen the appearance of facial wrinkles.

Muscle relaxants are also found in a combination drug with an anti-inflammatory agent like aspirin, or your healthcare provider may also suggest you use a non-steroidal anti-inflammatory agent (NSAIDs) like ibuprofen for added pain relief. Don't use aspirin and an NSAID together, unless approved by your doctor.

Rest and physical therapy are also important in the overall treatment plan for muscle spasm treatment.

Table 1. Common Muscle Relaxants

Alcohol should be avoided if you are under treatment with a centrally-acting muscle relaxant.

Generic Name	Brand Name Examples
abobotulinumtoxinA	Dysport
baclofen	Gablofen, Fleqsuvy, Lioresal, Ozobax, Lyvispah
carisoprodol	Soma
chlorzoxazone	none available
cyclobenzaprine	Amrix, Flexeril (brand discontinued)
dantrolene	Dantrium, Revonto, Ryanodex
incobotulinumtoxinA	Xeomin
metaxalone	Skelaxin
methocarbamol	Robaxin
onabotulinumtoxinA	Botox, Botox Cosmetic
orphenadrine	none available
prabotulinumtoxinA	Jeuveau
rimabotulinumtoxinB	Myobloc
tizanidine	Zanaflex

Previous research from the Substance Abuse and Mental Health Services Administration (SAMHSA) has shown that up to 18% of emergency department cases involving skeletal muscle relaxants also were linked with alcohol consumption. Carisoprodol and cyclobenzaprine are frequently misused for non-medical reasons.

Patient Tips for Muscle Relaxants

Centrally-acting agents can lead to added central nervous system depression when consumed with alcohol. Side effects such as dizziness, drowsiness, sedation, confusion, weakness and problems with judgement or thinking can occur.
Avoid hazardous activities such as driving, operating machinery, or engaging in high-risk activities.
Carisoprodol (Soma) is metabolized to meprobamate and can lead to an opiate-like effect when combined with alcohol. Avoid or limit the use of alcohol while being treated with carisoprodol
In addition to CNS depression, tizanidine may also have additive effects on lowering your blood pressure (hypotension) if combined with alcohol. You may experience headache, drowsiness, dizziness, lightheadedness, fainting, falling, difficulty concentrating, and/or changes in pulse or heart rate. Use caution when rising from a sitting or lying position.

Muscle relaxants are not recommended for use by pregnant women, older adults, or people who have a history of depression or drug or alcohol abuse.

Table 1 may not be a complete list; always check with your pharmacist for possible drug-alcohol interactions. Be sure to inform them of your prescription medications, as well as over-the-counter (OTC), vitamin and herbal or dietary products that you use.

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Sources

Witenko C, Moorman-Li R, Motycka C, et al. Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. P T. 2014;39(6):427–435. Accessed Feb 29, 2024 at PMID: 25050056
Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013. HHS Publication No. (SMA) 13-4760, DAWN Series D-39.
What are the Effects of Mixing Flexeril and Alcohol? Alcohol.org. Accessed Feb 29, 2024 at https://www.alcohol.org/mixing-with/flexeril/
Amrix Product Label. ECR Pharmaceuticals Inc.. Richmond, Virginia. Accessed Nov. 18, 2019 at https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/021777lbl.pdf

Further information

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