Drug interactions
Tizanidine + Verapamil
Severity: Moderate
Tizanidine and Verapamil: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Verapamil can raise tizanidine exposure, leading to excessive hypotension, bradycardia, drowsiness and dizziness. Tizanidine is cleared mainly by CYP1A2, and verapamil is a weak inhibitor of that enzyme. The effect is less pronounced than with strong CYP1A2 inhibitors, but additive blood pressure lowering is also a concern.
What this interaction means in plain words
Tizanidine and Verapamil can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Tizanidine belongs to Musculoskeletal; Verapamil belongs to Cardiovascular.
Why it happens
Verapamil weakly inhibits CYP1A2-mediated tizanidine metabolism, and both drugs lower blood pressure through additive pharmacodynamic effects.
What to do
Start tizanidine at a low dose and titrate slowly, monitoring blood pressure, heart rate and sedation. Reduce the tizanidine dose or choose another antispasticity agent if hypotension or marked drowsiness develops.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Tizanidine
- Ciprofloxacin + Tizanidine Contraindicated
- Fluvoxamine + Tizanidine Contraindicated
- Pefloxacin + Tizanidine Contraindicated
- Pipemidic acid + Tizanidine Contraindicated
- Benzhydrocodone / acetaminophen + Tizanidine Major
- Brexanolone + Tizanidine Major
Other interactions of Verapamil
- Dofetilide + Verapamil Contraindicated
- Flibanserin + Verapamil Contraindicated
- Lomitapide + Verapamil Contraindicated
- Lonafarnib + Verapamil Contraindicated
- Pimozide + Verapamil Contraindicated
- Acebutolol + Verapamil Major
Frequently asked questions
Can I take Tizanidine with Verapamil?
MediHelp rates the interaction as moderate. Tizanidine and Verapamil can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Verapamil can raise tizanidine exposure, leading to excessive hypotension, bradycardia, drowsiness and dizziness. Tizanidine is cleared mainly by CYP1A2, and verapamil is a weak inhibitor of that enzyme. The effect is less pronounced than with strong CYP1A2 inhibitors, but additive blood pressure lowering is also a concern.
How serious is the interaction between Tizanidine and Verapamil?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Start tizanidine at a low dose and titrate slowly, monitoring blood pressure, heart rate and sedation. Reduce the tizanidine dose or choose another antispasticity agent if hypotension or marked drowsiness develops.
What other medicines interact with Tizanidine?
MediHelp also lists interactions of Tizanidine with, for example, Ciprofloxacin, Fluvoxamine, Pefloxacin. The full list is on the Tizanidine page.
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