Deutsch Aaron B, Hartman Clare F, Flaherty Curtis P, Ebeling-Koning Natalie E, Beauchamp Gillian A, Katz Kenneth D
Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA.
Cureus. 2024 Feb 24;16(2):e54831. doi: 10.7759/cureus.54831. eCollection 2024 Feb.
Tizanidine is commonly prescribed for muscle spasticity and pain. Yet, withdrawal is rarely reported. Tizanidine stimulates presynaptic α-2 adrenergic and imidazoline receptors decreasing norepinephrine release. Abrupt cessation can cause withdrawal. Current treatment strategies include tapering oral tizanidine or substituting oral clonidine. A 52-year-old male with a history of hypertension, diabetes, coronary artery disease, and chronic back pain presented with altered mental status, agitation, hypertensive emergency (blood pressure: 250/145 mmHg), and tachycardia. The patient had been prescribed tizanidine for chronic back pain for two years and had recently run out with suspicion of misuse. Tizanidine withdrawal was diagnosed, and he improved with 0.1 mg oral clonidine three times daily weaned over five days while hospitalized. One month later the patient was admitted for persistent hypertension, tachycardia, diaphoresis, and anxiety. Alpha-2 agonist withdrawal was again diagnosed. Utilizing a clonidine patch taper may offer a reasonable approach in patients with tizanidine withdrawal.
替扎尼定常用于治疗肌肉痉挛和疼痛。然而，很少有关于其戒断反应的报道。替扎尼定刺激突触前α-2肾上腺素能受体和咪唑啉受体，减少去甲肾上腺素的释放。突然停药可能会导致戒断反应。目前的治疗策略包括逐渐减少口服替扎尼定剂量或改用口服可乐定。一名52岁男性，有高血压、糖尿病、冠状动脉疾病和慢性背痛病史，出现精神状态改变、烦躁不安、高血压急症（血压：250/145 mmHg）和心动过速。该患者因慢性背痛服用替扎尼定两年，近期因疑似药物滥用而停药。诊断为替扎尼定戒断反应，住院期间，通过每日三次口服0.1 mg可乐定，在五天内逐渐减量，患者病情好转。一个月后，该患者因持续性高血压、心动过速、多汗和焦虑再次入院。再次诊断为α-2激动剂戒断反应。对于替扎尼定戒断反应患者，使用可乐定贴片逐渐减量可能是一种合理的方法。
