Metaxalone

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# Overview
Metaxalone is a centrally acting skeletal muscle relaxant that is FDA approved for the {{{indicationType}}} of musculoskeletal pain.   Common adverse reactions include drug-induced gastrointestinal disturbance, nausea, vomiting, dizziness, headache, somnolence, feeling nervous.

# Adult Indications and Dosage

## FDA-Labeled Indications and Dosage (Adult)
- Dosing Information
- Metaxalone is indicated as an adjunct to rest, physical therapy, and other measures for the relief of discomforts associated with acute, painful musculoskeletal conditions. The mode of action of this drug has not been clearly identified, but may be related to its sedative properties. Metaxalone does not directly relax tense skeletal muscles in man.
- The recommended dose for adults is one 800 mg tablet three to four times a day.

## Off-Label Use and Dosage (Adult)

### Guideline-Supported Use
There is limited information regarding Off-Label Guideline-Supported Use of Metaxalone in adult patients.

### NonGuideline-Supported Use
There is limited information regarding Off-Label NonGuideline-Supported Use of Metaxalone in adult patients.

# Pediatric Indications and Dosage

## FDA-Labeled Indications and Dosage (Pediatric)
- Dosing Information
- The recommended dose for children over 12 years of age is one 800 mg tablet three to four times a day.

## Off-Label Use and Dosage (Pediatric)

### Guideline-Supported Use
There is limited information regarding Off-Label Guideline-Supported Use of Metaxalone in pediatric patients.

### NonGuideline-Supported Use
There is limited information regarding Off-Label NonGuideline-Supported Use of Metaxalone in pediatric patients.

# Contraindications
- Known hypersensitivity to any components of this product.
- Known tendency to drug induced, hemolytic, or other anemias.
- Significantly impaired renal or hepatic function.

# Warnings
- Metaxalone may enhance the effects of alcohol and other CNS depressants.

### Precautions
- Metaxalone should be administered with great care to patients with pre-existing liver damage. Serial liver function studies should be performed in these patients.
- False-positive Benedicts tests, due to an unknown reducing substance, have been noted. A glucose-specific test will differentiate findings.
- Taking metaxalone with food may enhance general CNS depression; elderly patients may be especially susceptible to this CNS effect.

# Adverse Reactions

## Clinical Trials Experience
- The most frequent reactions to metaxalone include:
Drowsiness, dizziness, headache, and nervousness or irritability;
Nausea, vomiting, gastrointestinal upset.
- Other adverse reactions are:
Hypersensitivity reaction, rash with or without pruritus;
Leukopenia; hemolytic anemia;
Jaundice.
- Though rare, anaphylactoid reactions have been reported with metaxalone.

## Postmarketing Experience
There is limited information regarding Postmarketing Experience of Metaxalone in the drug label.

# Drug Interactions
- The sedative effects of metaxalone and other CNS depressants (e.g., alcohol, benzodiazepines, opioids, tricyclic antidepressants) may be additive. Therefore, caution should be exercised with patients who take more than one of these CNS depressants simultaneously.

# Use in Specific Populations

### Pregnancy
Pregnancy Category (FDA):
- Pregnancy Category
- Reproduction studies in rats have not revealed evidence of impaired fertility or harm to the fetus due to metaxalone. Post marketing experience has not revealed evidence of fetal injury, but such experience cannot exclude the possibility of infrequent or subtle damage to the human fetus. Safe use of metaxalone has not been established with regard to possible adverse effects upon fetal development. Therefore, metaxalone tablets should not be used in women who are or may become pregnant and particularly during early pregnancy unless, in the judgement of the physician, the potential benefits outweigh the possible hazards.
Pregnancy Category (AUS):
- Australian Drug Evaluation Committee (ADEC) Pregnancy Category
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Metaxalone in women who are pregnant.

### Labor and Delivery
There is no FDA guidance on use of Metaxalone during labor and delivery.

### Nursing Mothers
- It is not known whether this drug is secreted in human milk. As a general rule, nursing should not be undertaken while a patient is on a drug since many drugs are excreted in human milk.

### Pediatric Use
- Safety and effectiveness in children 12 years of age and below have not been established.

### Geriatic Use
There is no FDA guidance on the use of Metaxalone with respect to geriatric patients.

### Gender
There is no FDA guidance on the use of Metaxalone with respect to specific gender populations.

### Race
There is no FDA guidance on the use of Metaxalone with respect to specific racial populations.

### Renal Impairment
There is no FDA guidance on the use of Metaxalone in patients with renal impairment.

### Hepatic Impairment
There is no FDA guidance on the use of Metaxalone in patients with hepatic impairment.

### Females of Reproductive Potential and Males
There is no FDA guidance on the use of Metaxalone in women of reproductive potentials and males.

### Immunocompromised Patients
There is no FDA guidance one the use of Metaxalone in patients who are immunocompromised.

# Administration and Monitoring

### Administration
- Oral

### Monitoring
There is limited information regarding Monitoring of Metaxalone in the drug label.

# IV Compatibility
There is limited information regarding IV Compatibility of Metaxalone in the drug label.

# Overdosage

## Acute Overdose

### Signs and Symptoms
- Deaths by deliberate or accidental overdose have occurred with metaxalone, particularly in combination with antidepressants, and have been reported with this class of drug in combination with alcohol.
- When determining the LD50 in rats and mice, progressive sedation, hypnosis and finally respiratory failure were noted as the dosage increased. In dogs, no LD50 could be determined as the higher doses produced an emetic action in 15 to 30 minutes.

### Management
- Gastric lavage and supportive therapy. Consultation with a regional poison control center is recommended.

## Chronic Overdose
There is limited information regarding Chronic Overdose of Metaxalone in the drug label.

# Pharmacology

## Mechanism of Action
- The mechanism of action of metaxalone in humans has not been established, but may be due to general central nervous system depression. Metaxalone has no direct action on the contractile mechanism of striated muscle, the motor end plate or the nerve fiber.

## Structure
- Metaxalone is available as an 800 mg, light pink to pink, capsule shaped, scored uncoated tablet.
- Chemically, metaxalone is 5--2-oxazolidinone. The empirical formula is C12H15NO3, which corresponds to a molecular weight of 221.25. The structural formula is:
- Metaxalone is a white to almost white, odorless crystalline powder freely soluble in chloroform, soluble in methanol and in 96% ethanol, but practically insoluble in ether or water.
- Each tablet contains 800 mg metaxalone and the following inactive ingredients: calcium carbonate, FD&C Red #40, hypromellose, lactose monohydrate, microcrystalline cellulose, povidone, silicone dioxide, sodium starch glycolate and sodium stearyl fumarate.

## Pharmacodynamics
There is limited information regarding Pharmacodynamics of Metaxalone in the drug label.

## Pharmacokinetics
- The pharmacokinetics of metaxalone have been evaluated in healthy adult volunteers after single dose administration of metaxalone under fasted and fed conditions at doses ranging from 400 mg to 800 mg.
- Absorption
- Peak plasma concentrations of metaxalone occur approximately 3 hours after a 400 mg oral dose under fasted conditions. Thereafter, metaxalone concentrations decline log-linearly with a terminal half-life of 9.0  4.8 hours. Doubling the dose of metaxalone from 400 mg to 800 mg results in a roughly proportional increase in metaxalone exposure as indicated by peak plasma concentrations (Cmax) and area under the curve (AUC). Dose proportionality at doses above 800 mg has not been studied. The absolute bioavailability of metaxalone is not known.
- The single-dose pharmacokinetic parameters of metaxalone in two groups of healthy volunteers are shown in Table 1.
- Food Effects
- A randomized, two-way, crossover study was conducted in 42 healthy volunteers (31 males, 11 females) administered one 400 mg metaxalone tablet under fasted conditions and following a standard high-fat breakfast. Subjects ranged in age from 18 to 48 years (mean age = 23.5  5.7 years). Compared to fasted conditions, the presence of a high fat meal at the time of drug administration increased Cmax by 177.5% and increased AUC (AUC0-t, AUC) by 123.5% and 115.4%, respectively. Time-to-peak concentration (Tmax) was also delayed (4.3 h versus 3.3 h) and terminal half-life was decreased (2.4 h versus 9.0 h) under fed conditions compared to fasted.
- In a second food effect study of similar design, two 400 mg metaxalone tablets (800 mg) were administered to healthy volunteers (N=59, 37 males, 22 females), ranging in age from 18 to 50 years (mean age = 25.6 8.7 years). Compared to fasted conditions, the presence of a high fat meal at the time of drug administration increased Cmax by 193.6% and increased AUC (AUC0-t, AUC) by 146.4% and 142.2%, respectively. Time-to-peak concentration (Tmax) was also delayed (4.9 h versus 3.0 h) and terminal half-life was decreased (4.2 h versus 8.0 h) under fed conditions compared to fasted conditions. Similar food effect results were observed in the above study when one metaxalone 800 mg tablet was administered in place of two metaxalone 400 mg tablets. The increase in metaxalone exposure coinciding with a reduction in half-life may be attributed to more complete absorption of metaxalone in the presence of a high fat meal (Figure 1).
- Distribution, Metabolism, and Excretion
- Although plasma protein binding and absolute bioavailability of metaxalone are not known, the apparent volume of distribution (V/F ~ 800 L) and lipophilicity (log P = 2.42) of metaxalone suggest that the drug is extensively distributed in the tissues. Metaxalone is metabolized by the liver and excreted in the urine as unidentified metabolites. Hepatic Cytochrome P450 enzymes play a role in the metabolism of metaxalone. Specifically, CYP1A2, CYP2D6, CYP2E1, and CYP3A4 and, to a lesser extent, CYP2C8, CYP2C9, and CYP2C19 appear to metabolize metaxalone.
- Metaxalone does not significantly inhibit major CYP enzymes such as CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1, and CYP3A4. Metaxalone does not significantly induce major CYP enzymes such as CYP1A2, CYP2B6, and CYP3A4 in vitro.
- Pharmacokinetics in Special Populations
- Age:
- The effects of age on the pharmacokinetics of metaxalone were determined following single administration of two 400 mg tablets (800 mg) under fasted and fed conditions. The results were analyzed separately, as well as in combination with the results from three other studies. Using the combined data, the results indicate that the pharmacokinetics of metaxalone are significantly more affected by age under fasted conditions than under fed conditions, with bioavailability under fasted conditions increasing with age.
- The bioavailability of metaxalone under fasted and fed conditions in three groups of healthy volunteers of varying age is shown in Table 2.
- Gender:
- The effect of gender on the pharmacokinetics of metaxalone was assessed in an open label study, in which 48 healthy adult volunteers (24 males, 24 females) were administered two metaxalone 400 mg tablets (800 mg) under fasted conditions. The bioavailability of metaxalone was significantly higher in females compared to males as evidenced by Cmax (2115 ng/mL versus 1335 ng/mL) and AUC (17884 ngh/mL versus 10328 ngh/mL). The mean half-life was 11.1 hours in females and 7.6 hours in males. The apparent volume of distribution of metaxalone was approximately 22% higher in males than in females, but not significantly different when adjusted for body weight. Similar findings were also seen when the previously described combined dataset was used in the analysis.
- Hepatic/Renal Insufficiency:
- The impact of hepatic and renal disease on the pharmacokinetics of metaxalone has not been determined. In the absence of such information, metaxalone should be used with caution in patients with hepatic and/or renal impairment.

## Nonclinical Toxicology
There is limited information regarding Nonclinical Toxicology of Metaxalone in the drug label.

# Clinical Studies
There is limited information regarding Clinical Studies of Metaxalone in the drug label.

# How Supplied
- Metaxalone is available as an 800 mg, light pink to pink, capsule shaped, scored uncoated  tablet with debossing AN on the left side of the scoring and 553 on the right side of the scoring. Other side of the tablet is plain.
- They are available as follows:
- Bottles of 100: NDC 68001-004-00
- Store at 20 to 25C (68 to 77F); excursions permitted to 15 to 30C (59 to 86F).

## Storage
There is limited information regarding Metaxalone Storage in the drug label.

# Images

## Drug Images

## Package and Label Display Panel

# Patient Counseling Information
- Metaxalone may impair mental and/or physical abilities required for performance of hazardous tasks, such as operating machinery or driving a motor vehicle, especially when used with alcohol or other CNS depressants.

# Precautions with Alcohol
- Alcohol-Metaxalone interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

# Brand Names
- METAXALONE

# Look-Alike Drug Names
There is limited information regarding Metaxalone Look-Alike Drug Names in the drug label.

# Drug Shortage Status

# Price