Is Cyclobenzaprine A Controlled Substance?

What you will learn

• Cyclobenzaprine is a prescription muscle relaxant that is not federally classified as a controlled substance under the Controlled Substances Act.
• Once sold as the branded drug Flexeril, cyclobenzaprine has a generally low potential for abuse.
• Abuse, side effects, and withdrawal are still possible, so always use as directed.

Cyclobenzaprine is not classified as a controlled substance, though it is potent, available by

prescription only, and not without potential side effects. It’s important to understand the key distinctions between cyclobenzaprine and drugs that carry a higher addiction potential.

When approached with respect and an informed, medically supervised plan, cyclobenzaprine can make a huge difference in your pain levels and quality of life. Read on to learn how cyclobenzaprine works, how it compares to other drugs, and more about its legal status.

What Exactly Does “Controlled” Mean?

In the United States, the term “controlled substance” refers to any drug, chemical, or other agent that the federal government regulates.

When the government determines that a particular drug or substance has a high enough potential for harm, abuse, or other adverse outcomes, it classifies it as a controlled substance. This comes with special restrictions and provisions.

The Drug Enforcement Administration (DEA), in adherence to the Controlled Substances Act (CSA), places controlled substances into one of five categories, or “schedules.” Schedule I is the most restrictive legal status, containing drugs that are highly addictive and not used for medical purposes. Schedule V is the least restrictive, regulating drugs with a low abuse potential.

While cyclobenzaprine is not in this list, it’s vital to understand that this is not an indicator of low potency or a lack of side effects. Serious side effects are still possible with this powerful drug.

How Does Cyclobenzaprine Work?

Cyclobenzaprine is an FDA-approved skeletal muscle relaxant medication. It is often used as an adjunct, or supplementary treatment, to physical therapy for patients with painful muscle spasms. It was once popularly available under the brand name Flexeril, which has been discontinued.

“Muscle spasms” is a generalized term that is associated with many conditions. The following are conditions and concerns that cyclobenzaprine can treat:[1]

• Acute musculoskeletal conditions: Repetitive motion injuries, overuse syndromes, back pain flare-ups, soft tissue disorders, and pain due to new (or old) injuries are all examples of acute musculoskeletal issues that may benefit from cyclobenzaprine.

• Fibromyalgia: While cyclobenzaprine is typically not recommended before other therapies like pregabalin and duloxetine, it has proven itself useful for fibromyalgia-related insomnia.

• TMJ disorder: TMJ stands for temporomandibular joint, which is where your lower jaw attaches to the skull (near the ear). Spasms due to TMJ injury or dysfunction can be relieved with cyclobenzaprine.
• Additional medication uses are being explored: Continued investigation of this muscle relaxant has unveiled a broader potential for treating conditions like PTSD. One finding, for example, showed that cyclobenzaprine consistently improved sleep and psychosocial function among PTSD patients while causing minimal adverse effects.[2]

As for the mechanism of action, cyclobenzaprine does not actually engage directly with the affected muscle(s). Instead, it engages with the central nervous system, possibly inhibiting the ability of a receptor (5-HT2) that causes muscle spasms.[3] Cyclobenzaprine does not improve spasticity, but only muscle spasms.

What About Side Effects?

Every drug comes with potential side effects, and cyclobenzaprine is no exception. Though generally well-tolerated when used as directed under medical supervision, cyclobenzaprine is still associated with minor and more serious side effects.

Common side effects of cyclobenzaprine include drowsiness, dizziness, confusion, and dry mucous membranes.[4] More serious side effects include hallucinations and psychosis.[5]

Several factors can increase your risk of experiencing certain adverse effects after taking cyclobenzaprine. For example, cyclobenzaprine may increase the frequency of manic episodes among patients with bipolar disorder.[6] The molecular structure of this muscle relaxant is similar to some antidepressants, which may be why it can affect conditions like bipolar.

Why Isn’t Cyclobenzaprine Controlled?

Cyclobenzaprine does not have a controlled substance classification because it has not been deemed by the DEA to have a high potential for abuse or addiction.

Some people have come to assume that cyclobenzaprine is a controlled substance because of the discontinuation of Flexeril. Flexeril was a branded formulation of cyclobenzaprine, featuring it as its active ingredient, that was used for most of the applications stated above.

Though there were legitimate concerns regarding the safety of that particular preparation, the discontinuation of Flexeril was also the result of economic (availability of much cheaper generics) and regulatory changes.

Flexeril was not discontinued because of a high incidence of addiction and abuse. However, this doesn’t mean that abuse is completely out of the picture. Cyclobenzaprine can still be abused, and it can still cause withdrawal symptoms.

Abuse Potential

First, it’s important to understand that any drug, whether it is deemed addictive or not, can foster a psychological or physical dependence. This is when a patient continues to use the drug despite negative consequences, which may or may not involve cravings, and can be driven by various psychological or physiological factors.

With this key distinction in mind, cyclobenzaprine may not be addictive like benzodiazepines or some other prescription drugs. However, there is still a measurable history of abuse attached to this drug. Typically, cyclobenzaprine by itself is combined with other medications or drugs when taken for recreational purposes.

A 2011 report on emergency department visits from the Substance Abuse and Mental Health Services Administration (SAMHSA) provides the following statistics:[7]

• There were 11,551 emergency department visits in 2011 related to “nonmedical use” of cyclobenzaprine. The greatest figure from that year was attached to pain relievers, for which 573,497 emergency department visits were reported.
• These 11,551 emergency department visits for nonmedical cyclobenzaprine use represent an increase of 87 percent from 2004, when there were 6,183 visits.
• There were 5,676 emergency department visits involving drug-related suicide attempts of people who took cyclobenzaprine in 2011.
• These 5,676 visits represent an increase of 91 percent since 2004, when there were 2,966 visits for this reason.
• Cyclobenzaprine accounted for more than half of the emergency department visits related to muscle relaxants during the 2004-2011 timeframe.

Cyclobenzaprine is rarely taken on its own for recreational purposes. It is most frequently prescribed as part of a short-term medication regimen lasting no longer than three or four weeks.

Psychological dependence is possible with long-term use, but otherwise uncommon. For these reasons, the drug remains unscheduled.

Cyclobenzaprine Withdrawal

The word “withdrawal” may seem contradictory when you’re referring to a non-addictive substance, but the two can very much co-exist. You don’t need to be addicted to a medication to experience symptoms when abruptly ceasing your use. Such is the case with cyclobenzaprine.

While cyclobenzaprine is generally used short-term and has a low risk of withdrawal symptoms when taken as prescribed, rare cases of withdrawal—particularly after prolonged or high-dose use—have been reported. Cyclobenzaprine withdrawal symptoms tend to mirror those of tricyclic antidepressants, since these two categories of medications are similar in structure.

Reported withdrawal symptoms of cyclobenzaprine may include gastrointestinal issues, sleep disturbances, irritability, and, rarely, agitation or other central nervous system effects.

Need Help? Don’t Hesitate to Ask

Whether you’re experiencing severe cyclobenzaprine withdrawal symptoms or you fear you’ve developed a dependence on the drug, the worst thing you can do is keep it to yourself.Professional and compassionate rehab services are not only for those recovering from more widely misused drugs. You, too, can access top-quality care as you navigate your recovery with the assistance of a trusted expert for the best outcomes.

Amanda is a prolific medical content writer specializing in eating disorders and addiction treatment. She graduated Magna Cum Laude from Purdue University with a B.S. in Social Work. Read more