Patient/caregiver was educated on precautions to be exercised while taking zanaflex as follows:
- Notify your doctor of any unresolving muscle spasms, progressively worsening muscle pain and discomfort, compromised range of motion in the involved muscle groups, and any continuing or worsening unpleasant side-effects, so that, your dosage on the medication could be revised.
- Zanaflex is mainly metabolized inside the body by the liver and is excreted out of the body in the urine by the kidneys. If liver is deficient, metabolism of the drug could be compromised, which can result in higher concentrations of the drug in the body for longer periods of time. If kidney function is deficient, elimination of the drug could be compromised, which also can result in higher concentrations of the drug in the body for longer periods of time. Either case can contribute to toxicity. While taking zanaflex, periodical labs could be ordered for evaluation of liver and kidney functions. So, maintain compliance with follow-up physician appointments and lab draws ordered. Be accommodative to the plan of dose changes accordingly to achieve an optimum response and prevent development of any undesired side-effects & toxicity.
- Zanaflex can rarely induce hepatic dysfunction and liver toxicity, leading to fatal liver failure. Individuals can present with symptoms of liver failure and jaundice, such as, yellowing of skin and eyes, dark yellow colored urine, itching of skin, upper right abdominal pain, abdominal distension, nausea and vomiting, confusion and disorientation, fluid retention in the body with swelling & acute weight gain, and compromised appetite. Also, in liver dysfunction, synthesis of clotting factors can be impaired, as liver is the primary site for clotting factor synthesis. This can lead to episodes of bleeding from the gastrointestinal and urinary tracts and bleeding episodes in the skin. Individuals with liver dysfunction can present with severe hemorrhages into the skin even from minor bruising, red tinged urine, fresh blood in the stool, or black tarry stool from partially digested blood in the intestines. While taking zanaflex, report any of these bleeding episodes to your physician immediately for appropriate measures to be considered. Also, individuals with inherently poor liver function can be at increased risk for liver toxicity with zanaflex. So, for individuals with history of compromised liver function, zanaflex must be either be avoided or used with caution, with close monitoring for symptoms of liver toxicity.
