Thiocolchicoside is widely used in acute muscular low back pain due to its fast-acting and less sedative profile. Tizanidine is better suited for chronic cases but requires monitoring due to sedative and hepatic effects. Baclofen is more useful for spasticity of CNS origin and is less commonly used for routine mechanical LBP.
| Parameter | Thiocolchicoside | Tizanidine | Baclofen |
|---|---|---|---|
| Class | Semi-synthetic derivative of colchicoside[1] | Centrally acting α2-adrenergic agonist[2] | GABAB receptor agonist[3] |
| Mechanism of Action | GABAA receptor modulator (exact mechanism unclear)[1] | Inhibits presynaptic motor neurons → reduces muscle tone[2] | Inhibits reflex transmission in spinal cord[3] |
| Primary Indication | Muscle spasms, acute back pain[1,4] | Spasticity, off-label use in LBP[2] | Spasticity of CNS origin, off-label in LBP[3,5] |
| Onset of Action | Within 1 hour[4] | 1–2 hours[2] | 1–2 hours[3] |
| Duration of Action | 6–12 hours[4] | 6–8 hours[2] | 4–8 hours[3] |
| Common Side Effects | Drowsiness, GI upset, allergic reactions[1] | Sedation, dry mouth, hypotension[2] | Drowsiness, weakness, dizziness[3] |
| Serious Side Effects | Seizure risk (high dose), teratogenicity[1,6] | Liver toxicity, hallucinations[2,6] | Seizures on abrupt withdrawal, confusion[3,6] |
| Pregnancy Category | Category X (Contraindicated) – teratogenic [6] | Category C[6] | Category C[6] |
| Lactation Category | Not recommended (Avoid due to genotoxic metabolite) | Use with caution (May be used short-term with infant monitoring) | Probably safe (Generally considered safe; monitor infant) |
| Dependency/Tolerance | Low[1] | Possible with long-term use[2] | Withdrawal risk if stopped suddenly[3] |
| Dose (Oral) | 4–8 mg BID[4] | 2–4 mg TID (start low, titrate)[2] | 5–10 mg TID (start low, titrate)[3] |
| Suitability for LBP | Preferred in acute muscular pain[4] | Useful in chronic muscular spasms[2] | Best in CNS-origin spasticity[3,5] |
| Cost and Availability | Widely available; moderate cost[7] | Widely available; moderate cost[7] | Widely available; inexpensive[7] |
References:
- Gatti D, et al. “Thiocolchicoside: a muscle relaxant with anti-inflammatory and analgesic properties.” Drugs Exp Clin Res. 2003.
- Wagstaff AJ, Bryson HM. “Tizanidine: a review of its pharmacology and clinical efficacy in the management of spasticity.” Drugs. 1997.
- Beard S, Hunn A, Wight J. “Baclofen for spasticity in children with cerebral palsy.” Cochrane Database. 2003.
- Gérard D. “Thiocolchicoside in the treatment of painful muscle spasms: a review.” Clin Drug Invest. 2002.
- Rizzo MA, Hadjimichael OC, Preiningerova J, Vollmer TL. “Prevalence and treatment of spasticity reported by multiple sclerosis patients.” Mult Scler. 2004.
- FDA Drug Label Database: Thiocolchicoside, Tizanidine, Baclofen Monographs.
- WHO Model List of Essential Medicines (2023); Local pharmacy survey data.