Elenbaas J K
Am J Hosp Pharm. 1980 Oct;37(10):1313-23.
A critical examination of the literature on centrally acting, orally administered skeletal muscle relaxants (SMRs) is presented. The available comparative clinical studies are reviewed, and the pharmacology, metabolism and adverse effects of the oral SMRs are discussed briefly. The drugs covered are carisoprodol, chlorphenesin carbamate, chlorzoxazone, cyclobenzaprine hydrochloride, diazepam, metaxalone, methocarbamol, and orphenadrine citrate. The mechanism of action of these agents is not well defined, and their effects are measured mainly by subjective responses. Thus, acceptable evidence of efficacy is difficult to obtain, especially if clinical studies continue to be designed inadequately. There are inadequate data to support the superiority of any one drug. Further, unique clinical efficacy of any oral SMR in comparison to nonspecific sedation has not been established. Based on subjective responses, all agents, except diazepam, have been shown to be superior to placebo in acute disorders; cyclobenzaprine has not been evaluated in acute conditions. SMRs are less effective in chronic disorders. Combination muscle relaxant-analgesic products appear to be superior to their individual components, but the relative efficacy of these combination products in comparison to combined use of individual sedative and analgesic agents is unknown.
本文对中枢作用的口服骨骼肌松弛剂（SMR）的文献进行了批判性审视。回顾了现有的比较临床研究，并简要讨论了口服SMR的药理学、代谢和不良反应。涵盖的药物有卡立普多、氯苯氨酯、氯唑沙宗、盐酸环苯扎林、地西泮、美他沙酮、美索巴莫和枸橼酸奥芬那君。这些药物的作用机制尚不明确，其效果主要通过主观反应来衡量。因此，很难获得可接受的疗效证据，尤其是如果临床研究的设计仍然不充分。没有足够的数据支持任何一种药物的优越性。此外，与非特异性镇静相比，任何口服SMR的独特临床疗效尚未确立。基于主观反应，除地西泮外，所有药物在急性疾病中均显示优于安慰剂；盐酸环苯扎林尚未在急性情况下进行评估。SMR在慢性疾病中效果较差。肌肉松弛剂-镇痛药组合产品似乎优于其单一成分，但这些组合产品与单独使用镇静剂和镇痛药相比的相对疗效尚不清楚。
