Is cyclobenzaprine pregnancy safe?

In this article:

• Cyclobenzaprine and pregnancy
• Potential risks
• Alternatives
• Natural remedies

In this article

• Cyclobenzaprine and pregnancy
• Potential risks
• Alternatives
• Natural remedies

Cyclobenzaprine is a prescription medication used to treat muscle spasms, stiffness, and pain. It is in a class of medications called skeletal muscle relaxants. Brand names include Amrix (an extended-release version of the drug that is taken once per day), Fexmid, and Flexeril (taken up to three times per day). In general, it is considered safe to use cyclobenzaprine during the second and third trimesters of pregnancy.

Can you take cyclobenzaprine while pregnant?

Typically, a woman would be prescribed cyclobenzaprine during pregnancy because of a muscle spasm, explains Kecia Gaither, MD, the  Director of Perinatal Services/Maternal Fetal Medicine at NYC Health + Hospitals/Lincoln in the Bronx in New York City.

Cyclobenzaprine is considered a category B medication by the FDA, which means that animal studies have not shown any adverse effects. It is generally considered safe to take cyclobenzaprine during pregnancy. There is very little human research on taking this drug during pregnancy. However, the consensus in the medical community is that it’s okay to take during the second and third trimesters (weeks 14 to 40 of pregnancy). Caution is important for all medications taken in the first trimester (0 to 13 weeks of pregnancy) when a baby’s organ systems are forming because there are no safety data available for the use of cyclobenzaprine in humans during the first trimester.

However, there is also concern about taking the medication during the last three months of pregnancy because “cyclobenzaprine produces drowsiness as a side effect, so the use of it in the third trimester may cause drowsiness in the newborn,” said Dr. Gaither.

In fact, this medication can be a safe alternative to other pain relievers for muscle spasms during pregnancy. “We find it works very well for people with some kind of musculoskeletal issue requiring relaxation,” explains Robert Atlas, MD, chair of the Department of Obstetrics and Gynecology at Mercy Medical Center in Baltimore, Maryland. “As much as we might like to use a nonsteroidal anti-inflammatory drug like Motrin during pregnancy, you’re generally not supposed to.”

It’s important to understand that cyclobenzaprine should only be used if needed and only as a short-term medication “It could be used for a couple of days up to a week or so,” says Dr. Atlas. “This isn’t something we’d use long-term, but something to help relieve pain in the short term.”

Plus, if you are planning on nursing, this medication is safe for breastfeeding. The amount of medication that transfers into human milk appears to be very small, according to a case report in the Journal of Human Lactation, and does not constitute a risk to a breastfed infant. Still, because the medication is a sedative, it is key to monitor your baby closely if you are taking cyclobenzaprine while breastfeeding.

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What are the risks of taking cyclobenzaprine while pregnant?

Because there is limited data on humans taking cyclobenzaprine while pregnant, it is difficult to identify all of the possible risks. Here’s what we know.

One study found increased odds of congenital disorders with the use of cyclobenzaprine during the time before conception and the first trimester. Still, the authors note that the results should be interpreted with caution, and more studies need to be done. Cyclobenzaprine does cross the placenta, which means that the fetus will be exposed to the medication along with the mother.

General side effects of cyclobenzaprine include drowsiness, dizziness, constipation, and dry mouth. It may also increase your heart rate or cause an irregular heartbeat (arrhythmia). If you experience chest pain or changes in your heart rate while taking cyclobenzaprine, stop taking it right away and contact a healthcare provider.

Cyclobenzaprine is part of a class of medications called cyclic antidepressants. It is considered a tricyclic amine salt, and it works in the central nervous system as a depressant by reducing muscle hyperactivity (otherwise known as muscle spasms). Because of this, a few kinds of medications do not mix with cyclobenzaprine:

• Selective serotonin reuptake inhibitors (SSRIs), such as Lexapro
• Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as Cymbalta
• Tricyclic antidepressants, like amitriptyline
• Benzodiazepines, like Xanax or Valium
• Barbiturates or opioids, such as morphine or tramadol
• Monoamine oxidase inhibitor (MAOIs)

While many of these medications are not recommended during pregnancy, it is recommended to avoid combining them with cyclobenzaprine because of the risk of serious side effects. Certain combinations of drugs can cause a condition called serotonin syndrome, which happens when there is a buildup of serotonin in your brain. It can be life-threatening and cause psychiatric problems.

You should not take cyclobenzaprine if you have a history of:

• Hyperthyroidism
• Myocardial infarction (heart attack)
• Arrhythmias (irregular heartbeat)
• Heart failure
• Heart block or conduction disturbance
• Glaucoma
• Urinary retention

If you do take cyclobenzaprine while pregnant, it is important to monitor yourself closely for side effects. The biggest side effect to watch for during pregnancy is drowsiness. Dr. Atlas says cyclobenzaprine is  “definitely sedating, so patients need to be careful about ambulation while on it—especially during pregnancy since balance can already be a challenge at that time.”

What can I take instead of cyclobenzaprine during pregnancy?

Despite the lack of research, cyclobenzaprine is generally considered the safest muscle relaxant to use during pregnancy. This is because it has been used in practice with pregnant people for years. While there are other options (such as carisoprodol, metaxalone, and tizanidine), alternative medications that work to relax muscles have even less research on their effects on pregnant people and babies.

The muscle relaxant that is best to take while pregnant will depend on your situation. You should discuss your options with your healthcare provider to determine which medication is right for you.

Natural remedies for muscle spasms during pregnancy

Whether you choose to take cyclobenzaprine or not, other therapies, treatments, and remedies can be helpful if you experience muscle spasms during pregnancy. These include:

• Massage
• Acupuncture
• Acupressure
• Epsom salt baths
• Applying heat or ice to the affected area
• Topical creams
• Physical therapy
• Stretching

Dr. Atlas advises, “Acupressure or acupuncture is very useful and safe in pregnancy. Warm baths can also be relaxing as long as the temperature isn’t too high, especially in the first trimester. At term, a bath at around 100°F is fine and can be helpful.”

It is unclear if taking vitamins or supplements is useful to help treat muscle spasms during pregnancy. While some people seem to find relief with magnesium supplementation to help with leg cramps (a type of muscle spasm) during pregnancy, a study did not find a reduction in the frequency and occurrence of leg cramps when women took oral magnesium.

Be sure to communicate with your provider or midwife if you are experiencing pain and need relief. Together, you can determine a plan to help your muscle spasms and ensure you feel better. It may make sense to use a combination of therapies, such as an over-the-counter (OTC) medication like acetaminophen, along with home remedies. If these therapies don’t give you relief from your muscle pain or spasm, work with your provider to determine if a muscle relaxant is right for you.