Is this possible??

[Racer15]

I had a patient refuse the Norflex the doctor had ordered, as they said they were allergic to Flexaril. They said it gave them muscle spasms?! But then promptly asked if I could get the doctor to order another muscle relaxer. I talked to the other nurses I was working with and they all said there is no way that this type of "allergy" was even possible. Is it?

[Esme12, ASN, BSN, RN]

Yeah, I knew it wasn't a true allergy, but when I asked my preceptor about it, he said it was impossible for a muscle relaxer to cause increased muscle spasms. The patient was asking me if Norflex was in the same category as Flexaril and I said well, yeah. I was just wondering if anyone had ever heard of muscle relaxers doing this to anyone else, my preceptor just figured this patient was drug seeking as they had had 1mg of Dilaudid less than an hour before.

Not true, your preceptor is mistaken.....Norflex can cause in some people a condition called tartive dyskensia.

is characterized by repetitive, involuntary, purposeless movements. Some examples of these types of involuntary movements include grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking. Rapid, involuntary movements of the limbs, torso, and fingers may also occur.In some cases, an individual's legs can be so affected that walking becomes difficult or impossible.

http://emedicine.medscape.com/article/1151826-overview medscape requires registration but it is FREE and an excellent resource/source

Anti-cholinergics

Anti-cholinergics (anti-spasmodics) are class of medications prescribed for respiratory problems such as COPD, bladder control problems, Parkinson’s disease, and other reasons. The following anti-cholinergics have commonly been given to help control some symptoms of Parkinson’s, but these drugs can cause tardive dyskinesia:

• Benzhexol

• Biperiden (brand name: Akineton)

• Ethopropazine

• Orphenadrine (brand names: Norflex, Norgesic, Orphengesic)

• Procylindine

[jadelpn, LPN, EMT-B]

Tardive Dyskenisia is a really serious side effect. And has to be treated as such as to not have permenant effects.

[Racer15, BSN, RN]

So the patient doesn't tolerate a med well and has asked for another...why is this an issue?

I guess I don't understand the question.

It doesn't really matter at this point if the reaction is an allergic response or an intolerance or a paradoxical effect...the patient doesn't want to take it because of the way it affected him and has requested another. That seems a perfectly reasonable thing to me.

Am I missing something?

You aren't missing anything. I've been an RN for two months, my preceptor (RN for three years) and another nurse that has been an LPN for many many more, both told me this was an impossible side effect and that this patient was drug seeking. I did not feel comfortable questioning their judgement, as I am still in orientation. I was also not aware that muscle relaxers could cause tardive dyskenisia, as in school it was only related to psych drugs, so thank you!

[BostonFNP, APRN]

You aren't missing anything. I've been an RN for two months, my preceptor (RN for three years) and another nurse that has been an LPN for many many more, both told me this was an impossible side effect and that this patient was drug seeking. I did not feel comfortable questioning their judgement, as I am still in orientation. I was also not aware that muscle relaxers could cause tardive dyskenisia, as in school it was only related to psych drugs, so thank you!

Always question people if you don't agree!

[Sadala, ADN, RN]

Also - gastro drugs are implicated in tardive dyskenesia, including

Reglan

Compazine

Propulsid

And norflex has caused dystonia in a handful of reported pts

[drowningdaily]

I had a horrible reaction to compazine - td. Before i was a nurse. It was my first pregnancy and my husband and I were terrified. I have seen a similar reaction to Flexeril. It was a while ago. Pt put on Soma with no problems.