Tolperisone

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Tolperisone, a piperidine derivative, is a centrally acting muscle relaxant. Trade names include Biocalm, Muscodol, Mydeton, Mydocalm, Myolax, Myoxan and Viveo.

Clinical use

In Tolperisone is indicated for use in the treatment of pathologically increased tone of the cross-striated muscle caused by neurological diseases (damage of the pyramidal tract, multiple sclerosis, myelopathy, encephalomyelitis) and of spastic paralysis and other encephalopathies manifested with muscular dystonia.^[1]^[2]

Other possible uses include:

Spondylosis
Spondylarthrosis
Cervical and lumbar syndromes
Arthrosis of the large joints
Obliterating atherosclerosis of the extremity vessels
Diabetic angiopathy
Thromboangiitis obliterans
Raynaud’s syndrome

Contraindications and cautions

Manufacturers report that tolperisone should not be used in patients with myasthenia gravis. Only limited data are available regarding the safety in children, youths, during pregnancy and breastfeeding. It is not known whether tolperisone is excreted into mother’s milk.^[1]^[2]

Side effects

Adverse effects occur in fewer than 1% of patients and include muscle weakness, headache, arterial hypotension, nausea, vomiting, dyspepsia, and dry mouth. All effects are reversible.^[1]^[2] Allergic reactions occur in fewer than 0.1% of patient and include skin rash, hives, Quincke’s edema, and in some cases anaphylactic shock.^[1]^[3]^[4]^[5]

Overdose

Excitability has been noted after ingestion of high doses by children.^[1] In suicide studies of three isolated cases, it is believed that ingestion of tolperisone was the cause of death.^[6]

Interactions

Tolperisone does not have a significant potential for interactions with other pharmaceutical drugs. It cannot be excluded that combination with other centrally acting muscle relaxants, benzodiazepines or non-steroidal anti-inflammatory drugs (NSAIDs) may make a dose reduction necessary in some patients.^[1]^[2]

Mechanism of action

Tolperisone is a centrally acting muscle relaxant that acts at the reticular formation in the brain stem^[1] by blocking voltage-gated sodium and calcium channels.^[7]^[8]

Pharmacokinetics

Tolperisone is absorbed nearly completely from the gut and reaches its peak blood plasma concentration after 1.5 hours. It is extensively metabolised in the liver and kidneys. The substance is excreted via the kidneys in two phases; the first with a half-life of two hours, and the second with a half-life of 12 hours.^[1]

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 ^1.6 ^1.7 Jasek, W, ed. (2007). Austria-Codex (in German) (62nd ed.). Vienna: Österreichischer Apothekerverlag. pp. 5510–1. ISBN 978-3-85200-181-4.
↑ ^2.0 ^2.1 ^2.2 ^2.3 “Midocalm”. Romania: InfoMedic.
↑ Ribi C, Vermeulen C, Hauser C (2003). “Anaphylactic reactions to tolperisone (Mydocalm)”. Swiss Medical Weekly. 133 (25–26): 369–371. PMID 12947534.
↑ Kwaśniewski A, Korbuszewska-Gontarz B, Mika S (2003). “[Mydocalm causing anaphylaxis]”. Pneumonol Alergol Pol (in Polish). 71 (5–6): 250–2. PMID 14587432. |access-date= requires |url= (help)
↑ Glück J, Rymarczyk B, Rogala B (2011). “An immediate hypersensitivity reaction caused by tolperisone hydrochloride”. J Investig Allergol Clin Immunol. 21 (5): 411–2. PMID 21905508. |access-date= requires |url= (help)
↑ Sporkert, F.; Brunel, C.; Augsburger, M. P.; Mangin, P. (2012). “Fatal tolperisone poisoning: Autopsy and toxicology findings in three suicide cases”. Forensic Science International. 215 (1): 101–104. doi:10.1016/j.forsciint.2011.05.025. PMID 21683537.
↑ Kocsis P, Farkas S, Fodor L, Bielik N, Thán M, Kolok S, Gere A, Csejtei M, Tarnawa I (2005). “Tolperisone-type drugs inhibit spinal reflexes via blockade of voltage-gated sodium and calcium channels”. Journal of Pharmacology and Experimental Therapeutics. 315 (3): 1237–1246. doi:10.1124/jpet.105.089805. PMID 16126840.
↑ Hofer D, Lohberger B, Steinecker B, Schmidt K, Quasthoff S, Schreibmayer W (2006). “A comparative study of the action of tolperisone on seven different voltage dependent sodium channel isoforms”. European Journal of Pharmacology. 538 (1–3): 5–14. doi:10.1016/j.ejphar.2006.03.034. PMID 16650844.

External links

[Austria-Codex-1] 1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 ^1.6 ^1.7 Jasek, W, ed. (2007). Austria-Codex (in German) (62nd ed.). Vienna: Österreichischer Apothekerverlag. pp. 5510–1. ISBN 978-3-85200-181-4.

[Midocalm-ro-2] 2.0 ^2.1 ^2.2 ^2.3 “Midocalm”. Romania: InfoMedic.

[3] Ribi C, Vermeulen C, Hauser C (2003). “Anaphylactic reactions to tolperisone (Mydocalm)”. Swiss Medical Weekly. 133 (25–26): 369–371. PMID 12947534.

[pmid14587432-4] Kwaśniewski A, Korbuszewska-Gontarz B, Mika S (2003). “[Mydocalm causing anaphylaxis]”. Pneumonol Alergol Pol (in Polish). 71 (5–6): 250–2. PMID 14587432. |access-date= requires |url= (help)

[pmid21905508-5] Glück J, Rymarczyk B, Rogala B (2011). “An immediate hypersensitivity reaction caused by tolperisone hydrochloride”. J Investig Allergol Clin Immunol. 21 (5): 411–2. PMID 21905508. |access-date= requires |url= (help)

[6] Sporkert, F.; Brunel, C.; Augsburger, M. P.; Mangin, P. (2012). “Fatal tolperisone poisoning: Autopsy and toxicology findings in three suicide cases”. Forensic Science International. 215 (1): 101–104. doi:10.1016/j.forsciint.2011.05.025. PMID 21683537.

[7] Kocsis P, Farkas S, Fodor L, Bielik N, Thán M, Kolok S, Gere A, Csejtei M, Tarnawa I (2005). “Tolperisone-type drugs inhibit spinal reflexes via blockade of voltage-gated sodium and calcium channels”. Journal of Pharmacology and Experimental Therapeutics. 315 (3): 1237–1246. doi:10.1124/jpet.105.089805. PMID 16126840.

[8] Hofer D, Lohberger B, Steinecker B, Schmidt K, Quasthoff S, Schreibmayer W (2006). “A comparative study of the action of tolperisone on seven different voltage dependent sodium channel isoforms”. European Journal of Pharmacology. 538 (1–3): 5–14. doi:10.1016/j.ejphar.2006.03.034. PMID 16650844.

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