Tizanidine (Zanaflex) - Complete Drug Information

Tizanidine (Zanaflex, Ternaline) is a short-acting muscle relaxant that is used to treat muscle spasticity due to a variety of conditions. These may include cerebral palsy, multiple sclerosis, stroke, and tetanus. Treatment should be done with tizanidine for daily activities and times when relief of spasticity is most important.

Tizanidine dose in Adults

Tizanidine dosage in the treatment of Muscle spasticity:

- Initially, 2 mg up to 3 times daily is given as needed
- It may be increase based on response and tolerability in 2 to 4 mg increments per dose (with a minimum of 1 to 4 days between dose increases)
- the maximum dose is 36 mg/day.
Discontinuation of therapy:
- Slowly taper dose by 2 to 4 mg daily.

Tizanidine dose in children:

The tablet and capsule dosage forms are not bioequivalent when given with food.

Dosage in the treatment of Spasticity associated with cerebral palsy:
- Initial dose:
- Children 2 to <10 years:
  - Orally 1 mg at bedtime then titrate as needed
- Children ≥10 years and adolescents:
  - Orally 2 mg at bedtime then titrate as needed
Titration and maintenance dosage:
- Children ≥2 years and Adolescents:
  - Titrate starting dose upward to the reported effective range of 0.3 to 0.5 mg/kg/day in 3 to 4 divided doses;
  - The maximum daily dose is 24 mg/day.
  - In adults, when the stoppage of therapy is necessary, doses are gradually tapered by 2 to 4 mg daily.

Tizanidine Pregnancy Risk Factor C

Some animal reproduction studies showed adverse events.

Use of Tizanidine while breastfeeding:

Although excretion in breastmilk is not known, it may be due to lipid solubility.

Tizanidine dose in Kidney disease:

CrCl ≥25 mL/minute:
- No dosage adjustment given in manufacturer’s labeling; however, caution is needed as creatinine clearance decreases.
CrCl <25 mL/minute:
- Use cautiously; clearance reduced >50%.
- During initial dose titration, use low doses.
- If higher doses are required, increase dose instead of increasing dosing frequency.

Tizanidine dose in liver disease:

Avoid use in hepatic derangement;
if used, then reduce dose during initial dose titration.
If higher doses are required, increase dose instead of increasing dosing frequency.
Monitor aminotransferases.

Common Side Effects of Tizanidine Include:

Cardiovascular:
- - Hypotension
Central Nervous System:
- Drowsiness
- Dizziness
Gastrointestinal:
- Xerostomia
Neuromuscular & Skeletal:
- Asthenia

Less Common Side Effects of Tizanidine Include:

Cardiovascular:
- Bradycardia
Central Nervous System:
- Nervousness
- Speech Disturbance
- Delusion
- Visual Hallucination
Gastrointestinal:
- Constipation
- Vomiting
Genitourinary:
- Urinary Tract Infection
- Urinary Frequency
Hepatic:
- Abnormal Hepatic Function Tests
Infection:
- Infection
Neuromuscular & Skeletal:
- Dyskinesia
Ophthalmic:
- Blurred Vision
Respiratory:
- Flu-Like Symptoms
- Pharyngitis
- Rhinitis

Rare side effects of Tizanidine:

Central nervous system:
- Drug withdrawal
- Sedated state
Hypersensitivity:
- Hypersensitivity reaction

Contraindication to Tizanidine Include:

Concomitant treatment with ciprofloxacin (potent CYP1A2 inhibitors)

Warnings and precautions

Hepatic effects:
- It could cause hepatotoxicity Monitor aminotransferases prior to and during use, or if you suspect that you may have a hepatic injury.
Hypersensitivity reactions:
- Use of the medication has been associated with hypersensitivity reactions such as anaphylaxis and angioedema, respiratory impairment, and urticaria.
- Allergy symptoms should be reported to the doctor immediately.
Hypotension:
- Syncope and hypotension can be severe. Patients at high risk of severe hypotensive effects (eg patients on concurrent medications that may increase their chances of developing hypotension) should be cautious.
- You can minimize hypotension effects by increasing the dose and monitoring for signs or symptoms.
Sedation
- Sedation is possible
- use cautiously in patients at risk for sedative effects (eg, patients taking concurrent CNS depressants);
- Patients should be advised about tasks that require mental alertness, such as driving or operating machinery. Visual hallucinations
- It is often associated with visual hallucinations and delusions.
- Patients with psychiatric disorders should be cautious.
- If hallucinations are a problem, you might want to stop therapy.
Hepatic impairment
- Patients with hepatic impairment should not use this product.
- Due to the extensive liver metabolism of tizanidine, it could have side effects.
Renal impairment:
- Patients with renal dysfunction should be treated with caution.
- Clearance was significantly lower in patients with severe impairment (CrCl 25mL/minute).
- Dose reductions are recommended.

Tizanidine: Drug Interaction

Risk Factor C (Monitor therapy)
Abiraterone Acetate	May increase the serum concentration of CYP1A2 Substrates (High risk with Inhibitors).
Alcohol (Ethyl)	CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl).
Alfuzosin	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Alizapride	May enhance the CNS depressant effect of CNS Depressants.
Amiodarone	May increase the serum concentration of TiZANidine.
Angiotensin-Converting Enzyme Inhibitors	TiZANidine may enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors.
Antipsychotic Agents (Second Generation [Atypical])	Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]).
Barbiturates	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Benperidol	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Blood Pressure Lowering Agents	May enhance the hypotensive effect of HypotensionAssociated Agents.
Bradycardia-Causing Agents	May enhance the bradycardic effect of other Bradycardia-Causing Agents.
Bretylium	May enhance the bradycardic effect of Bradycardia-Causing Agents. Bretylium may also enhance atrioventricular (AV) blockade in patients receiving AV blocking agents.
Brexanolone	CNS Depressants may enhance the CNS depressant effect of Brexanolone.
Brimonidine (Topical)	May enhance the CNS depressant effect of CNS Depressants.
Brimonidine (Topical)	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Bromopride	May enhance the CNS depressant effect of CNS Depressants.
Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Cannabis	May enhance the CNS depressant effect of CNS Depressants.
Chlorphenesin Carbamate	May enhance the adverse/toxic effect of CNS Depressants.
CNS Depressants	May enhance the adverse/toxic effect of other CNS Depressants.
Diazoxide	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Dimethindene (Topical)	May enhance the CNS depressant effect of CNS Depressants.
Doxylamine	May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended.
Dronabinol	May enhance the CNS depressant effect of CNS Depressants.
DULoxetine	Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine.
Esketamine	May enhance the CNS depressant effect of CNS Depressants.
Herbs (Hypotensive Properties)	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
HydrOXYzine	May enhance the CNS depressant effect of CNS Depressants.
Hypotension-Associated Agents	Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents.
Ivabradine	Bradycardia-Causing Agents may enhance the bradycardic effect of Ivabradine.
Kava Kava	May enhance the adverse/toxic effect of CNS Depressants.
Lacosamide	Bradycardia-Causing Agents may enhance the AV-blocking effect of Lacosamide.
Levodopa-Containing Products	Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products.
Lisinopril	TiZANidine may enhance the hypotensive effect of Lisinopril.
Lofexidine	May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Lormetazepam	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Magnesium Sulfate	May enhance the CNS depressant effect of CNS Depressants.
MetyroSINE	CNS Depressants may enhance the sedative effect of MetyroSINE.
Midodrine	May enhance the bradycardic effect of Bradycardia-Causing Agents.
Minocycline	May enhance the CNS depressant effect of CNS Depressants.
Molsidomine	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Nabilone	May enhance the CNS depressant effect of CNS Depressants.
Naftopidil	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Nicergoline	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Nicorandil	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Nitroprusside	Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside.
Pentoxifylline	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Pholcodine	Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine.
Phosphodiesterase 5 Inhibitors	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Piribedil	CNS Depressants may enhance the CNS depressant effect of Piribedil.
Pramipexole	CNS Depressants may enhance the sedative effect of Pramipexole.
Prostacyclin Analogues	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Quinagolide	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
ROPINIRole	CNS Depressants may enhance the sedative effect of ROPINIRole.
Rotigotine	CNS Depressants may enhance the sedative effect of Rotigotine.
Rufinamide	May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced.
Ruxolitinib	May enhance the bradycardic effect of Bradycardia-Causing Agents. Management: Ruxolitinib Canadian product labeling recommends avoiding use with bradycardia-causing agents to the extent possible.
Selective Serotonin Reuptake Inhibitors	CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced.
Serotonin/Norepinephrine Reuptake Inhibitors	May diminish the antihypertensive effect of Alpha2-Agonists.
Terlipressin	May enhance the bradycardic effect of Bradycardia-Causing Agents.
Tetrahydrocannabinol	May enhance the CNS depressant effect of CNS Depressants.
Tetrahydrocannabinol and Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Tobacco (Smoked)	May decrease the serum concentration of TiZANidine.
Tofacitinib	May enhance the bradycardic effect of Bradycardia-Causing Agents.
Trimeprazine	May enhance the CNS depressant effect of CNS Depressants.
Risk Factor D (Consider therapy modification)
Amifostine	Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered.
Beta-Blockers	Alpha2-Agonists may enhance the AV-blocking effect of Beta-Blockers. Sinus node dysfunction may also be enhanced. Beta-Blockers may enhance the rebound hypertensive effect of Alpha2-Agonists. This effect can occur when the Alpha2-Agonist is abruptly withdrawn. Management: Closely monitor heart rate during treatment with a beta blocker and clonidine. Withdraw beta blockers several days before clonidine withdrawal when possible, and monitor blood pressure closely. Recommendations for other alpha2-agonists are unavailable. Exceptions: Levobunolol; Metipranolol.
Blonanserin	CNS Depressants may enhance the CNS depressant effect of Blonanserin.
Buprenorphine	CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants.
Ceritinib	Bradycardia-Causing Agents may enhance the bradycardic effect of Ceritinib. Management: If this combination cannot be avoided, monitor patients for evidence of symptomatic bradycardia, and closely monitor blood pressure and heart rate during therapy. Exceptions are discussed in separate monographs.
Chlormethiazole	May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used.
CYP1A2 Inhibitors (Moderate)	May increase the serum concentration of TiZANidine. Management: If combined use cannot be avoided, initiate tizanidine in adults at 2 mg and increase in 2 to 4 mg increments based on patient response. Monitor for increased effects of tizanidine, including adverse reactions. Exceptions: Ciprofloxacin (Systemic).
CYP1A2 Inhibitors (Weak)	May increase the serum concentration of TiZANidine. Management: Avoid these combinations when possible. If combined use is necessary, initiate tizanidine at an adult dose of 2 mg and increase in 2 to 4 mg increments based on patient response. Monitor for increased effects of tizanidine, including adverse reactions.
Droperidol	May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Flunitrazepam	CNS Depressants may enhance the CNS depressant effect of Flunitrazepam.
HYDROcodone	CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Methotrimeprazine	CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established.
Mirtazapine	May diminish the antihypertensive effect of Alpha2-Agonists. Management: Consider avoiding concurrent use. If the combination cannot be avoided, monitor for decreased effects of alpha2-agonists if mirtazapine is initiated/dose increased, or increased effects if mirtazapine is discontinued/dose decreased.
Obinutuzumab	May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion.
Opioid Agonists	CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
OxyCODONE	CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Perampanel	May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination.
Siponimod	Bradycardia-Causing Agents may enhance the bradycardic effect of Siponimod. Management: Avoid coadministration of siponimod with drugs that may cause bradycardia.
Sodium Oxybate	May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated.
Suvorexant	CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended.
Tapentadol	May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Tricyclic Antidepressants	May diminish the antihypertensive effect of Alpha2-Agonists. Management: Consider avoiding this combination. If used, monitor for decreased effects of the alpha2-agonist. Exercise great caution if discontinuing an alpha2-agonist in a patient receiving a TCA.
Vemurafenib	May increase the serum concentration of CYP1A2 Substrates (High risk with Inhibitors). Management: Consider alternatives to such combinations whenever possible, particularly if the CYP1A2 substrate has a relatively narrow therapeutic index. Drugs listed as exceptions to this monograph are discussed in separate drug interaction monographs.
Zolpidem	CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol.
Risk Factor X (Avoid combination)
Azelastine (Nasal)	CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal).
Bromperidol	Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents.
Bromperidol	May enhance the CNS depressant effect of CNS Depressants.
Ciprofloxacin (Systemic)	May increase the serum concentration of TiZANidine.
CYP1A2 Inhibitors (Strong)	May increase the serum concentration of TiZANidine.
Orphenadrine	CNS Depressants may enhance the CNS depressant effect of Orphenadrine.
Oxomemazine	May enhance the CNS depressant effect of CNS Depressants.
Paraldehyde	CNS Depressants may enhance the CNS depressant effect of Paraldehyde.
Thalidomide	CNS Depressants may enhance the CNS depressant effect of Thalidomide.

Monitor:

Monitor liver function (aminotransferases) at baseline and 1 month after maximum dose achieved or if hepatic injury is suspected;
blood pressure
renal function

How to Administer Tizanidine?

Oral:

Capsules may be opened and contents can be sprinkled on food;
Absorption is increased by up to 20% relative to the administration of the capsule in fasted conditions.

Mechanism of action of Tizanidine:

It is an alpha-adrenergic antagonist agent that decreases spasticity through increasing presynaptic inhibition.
Its greatest effects are on polysynaptic channels; the overall effect is to decrease facilitation of spinal motor neuron.

Onset: Single-dose (8 mg):

Peak effect is seen in 1 to 2 hours
Duration: Single-dose (8 mg): 3 - 6 hours

Absorption:

Tablets and capsules are bioequivalent under fasting conditions, but not in nonfasting conditions.
Tablets administered with food:
Peak plasma concentration is increased by almost 30%;
time to peak increased by 25 minutes;
The extent of absorption increased by almost 30%.

Capsules administered with food:

Peak plasma concentration decreased by 20%;
time to peak increased by 2 - 3 hours;
The extent of absorption increased by almost 10%.
Capsules opened and sprinkled on applesauce are not bioequivalent to administration of intact capsules in fasting conditions.
Peak plasma concentration and AUC are increased by 15% - 20%; time to peak decreased by 15 minutes.

Distribution: IV: 2.4 L/kg

Protein binding: almost 30%

Metabolism: Extensive hepatic metabolism via CYP1A2 to inactive metabolites

Bioavailability: almost 40% (extensive first-pass metabolism)

Half-life elimination: almost 2.5 hours

Time to peak, serum:

Fasting state:
- Capsule, tablet: 1 hour
Fed state:
- Capsule: 3 to 4 hours, Tablet: 1.5 hours

Excretion: In Urine (60%) & feces (20%)

International Brands of Tizanidine:

GEN-TiZANidine
MYLAN-Ti
ZANidine
PAL-TiZANidine
KaiLaiTong
Mio-Relax
Musant
Musrel
Myores
Myos-Nor
Myoxyl
Phardex
Rekan
Relentus
Remus
Sirdalud
Sirdalud MR
Sirdalud Retard
Sirdalum
Spaslax
Stidine
Ternelin
Tilax
Tizadin
Tizalin
Tizalud
Tizan
Tizanac
Tizarid
Tizigesic
Tizyl
Tonolyte 2
Tonolyte 4
Zanaflex
Zita
Zitanid

Tizanidine brands in Pakistan:

Tizanidine [Tabs 1 Mg]
Xandi	Evergreen Pharmaceuticals Pvt Limited

Tizanidine [Tabs 2 Mg]
Agile	Wilshire Laboratories (Pvt) Ltd.
Analar	Agp (Private) Ltd.
Arcozid	Pakistan Pharmaceutical Products (Pvt) Ltd.
Azanid	Usawa Pharmaceuticals
Bionergics	Biorex Pharmaceuticals
D-Tone	Standpharm Pakistan (Pvt) Ltd.
Fernor	Amarant Pharmaceuticals (Pvt)
Kadin	Fynk Pharmaceuticals
Kromis	Unimark Pharmaceuticals
Lentil	Adamjee Pharmaceuticals (Pvt) Ltd.
Lintiz	Bosch Pharmaceuticals (Pvt) Ltd.
Makrelex	Makson Pharmaceuticals
Maxlax	Genix Pharma (Pvt) Ltd
Micnic	Zephyr Pharmatec (Pvt) Ltd.
Mizenax	Ambrosia Pharmaceuticals
Molluscus	Epoch Pharmaceutical
Movax	Sami Pharmaceuticals (Pvt) Ltd.
Movcolm	Semos Pharmaceuticals (Pvt) Ltd.
Movcolm	Semos Pharmaceuticals (Pvt) Ltd.
Move-Ease	Tagma Pharma (Pvt) Ltd.
Mudine	Rakaposhi Pharmaceutical (Pvt) Ltd.
Mural	Paramount Pharmaceuticals
Murex	Silver Oak Corporation.
Musidin	Martin Dow Pharmaceuticals (Pak) Ltd.
Muslex	Danas Pharmaceuticals (Pvt) Ltd
Musnide	Medifine Laboratories
Musrel	Well & Well Pharma (Pvt) Ltd
Mutin	Zesion Pharmaceutical (Pvt) Ltd
Mylex	Genome Pharmaceuticals (Pvt) Ltd
Mylifam	Qintar Pharmacuticals
Myodine	Envoy Pharma
Myzan	Cherwel Pharmaceuticals (Pvt) Ltd
Nazeden	Hygeia Pharmaceuticals
Neutize	Max Pharmaceuticals
Nimrelex	Nimrall Laboratories
Nyer	Medisure Laboratories Pakistan (Pvt.) Ltd.
Ortizidine	Orta Labs. (Pvt) Ltd.
Redeem	Pulse Pharmaceuticals
Relaxadine	Lotus Pharmaceuticals (Pvt) Ltd
Relaxamed	Medicraft Pharmaceuticals (Pvt) Ltd.
Relaxit	Glitz Pharma
Rexant	Helix Pharma (Private) Limited
Rexant	Helix Pharma (Private) Limited
Skelgesic	Werrick Pharmaceuticals
Skelwin	Wns Field Pharmaceuticals
Sketeez	Neo Medix
Soneta	Atco Laboratories Limited
Spasfree	Vega Pharmaceuticals Ltd.
Spastiz	Medera Pharmaceuticals (Pvt) Ltd.
Strive	Star Laboratories (Pvt) Ltd.
Swanzid	Swan Pharmaceuticals(Pvt) Ltd
T-Lex	Getz Pharma Pakistan (Pvt) Ltd.
Tanin	Mass Pharma (Private) Limited
Tanzic	Everest Pharmaceuticals
Tazadin	Shawan Pharmaceuticals
Temel	Aries Pharmaceuticals (Pvt) Ltd
Terladin	Sapient Pharma
Terlax	Barrett Hodgson Pakistan (Pvt) Ltd.
Ternelin	Novartis Pharma (Pak) Ltd
Tigesic	Healthtek (Pvt) Ltd
Tinadine	Hyan Pharma
Tinic	Shazals Pharmaceuticals
Tinize Tablet	Akson Pharmaceuticals (Pvt) Ltd.
Tinza	Saydon Pharmaceutical Industries (Pvt) Ltd.
Tizadin	Shazals Pharmaceuticals
Tizanaflex	Webros Pharmaceuticals
Tizaniadvan	Advanced Pharmaceuticals
Tizenedal	Alson Pharmaceuticals
Tizigood	Goodman Laboratories
Tizilex	Tabros Pharma
Tizmin	Everest Pharmaceuticals
Tizocin	Akson Pharmaceuticals (Pvt) Ltd.
Tizodine	Batala Pharmaceuticals.
Tizom	Caraway Pharmaceuticals
Tizorel	Merck Private Ltd.
Tizpa	S.J. & G. Fazul Ellahie (Pvt) Ltd.
Tonsic	Raazee Theraputics (Pvt) Ltd.
Trajin	Pharmedic (Pvt) Ltd.
Transdin	Unison Chemical Works
Trizadine	Fassgen Pharmaceuticals
Tyzan	Breeze Pharma (Pvt) Ltd
Unixidine	Tg Pharma
Zadin	Bio Labs (Pvt) Ltd.
Zadine	Miracle Pharmaceuticals(Pvt) Ltd
Zandic	Mega Pharmaceuticals (Pvt) Ltd
Zandin	Mediceena Pharma (Pvt) Ltd.
Zanidine	Helicon Pharmaceutek Pakistan (Pvt) Ltd.
Zaniflex	Platinum Pharmaceuticals (Pvt.) Ltd.
Zantid	Sante (Pvt) Limited
Zinad	Rasco Pharma
Zita	Gray`S Pharmaceuticals

Tizanidine [Tabs 4 Mg]
Agile Forte	Wilshire Laboratories (Pvt) Ltd.
Fernor	Amarant Pharmaceuticals (Pvt)
Lintiz	Bosch Pharmaceuticals (Pvt) Ltd.
Makrelex	Makson Pharmaceuticals
Maxlax	Genix Pharma (Pvt) Ltd
Micnic	Zephyr Pharmatec (Pvt) Ltd.
Movax	Sami Pharmaceuticals (Pvt) Ltd.
Move-Ease	Tagma Pharma (Pvt) Ltd.
Mr-X	Jawa Pharmaceuticals(Pvt) Ltd.
Mural	Paramount Pharmaceuticals
Musidin	Martin Dow Pharmaceuticals (Pak) Ltd.
Musrel	Well & Well Pharma (Pvt) Ltd
Mylex	Genome Pharmaceuticals (Pvt) Ltd
Myodine	Envoy Pharma
Myzan	Cherwel Pharmaceuticals (Pvt) Ltd
Neutize	Max Pharmaceuticals
Swanzid	Swan Pharmaceuticals(Pvt) Ltd
Taixa	Noa Hemis Pharmaceuticals
Tanavax	Axis Pharmaceuticals
Tazadin	Shawan Pharmaceuticals
Tazalex	Wise Pharmaceuticals (Pvt) Ltd
Terlax	Barrett Hodgson Pakistan (Pvt) Ltd.
Ternelin	Novartis Pharma (Pak) Ltd
Tilaxin	Harrison Pharmaceuticals
Tinic	Shazals Pharmaceuticals
Tinza	Saydon Pharmaceutical Industries (Pvt) Ltd.
Tized	Polyfine Chempharma (Pvt) Ltd.
Tizenax	Caraway Pharmaceuticals
Tizigood	Goodman Laboratories
Tizilex	Tabros Pharma
Tizorel	Merck Private Ltd.
Tizpa	S.J. & G. Fazul Ellahie (Pvt) Ltd.
X-Tans	Saaaf Pharmaceuticals
Zadin	Bio Labs (Pvt) Ltd.
Zandic	Mega Pharmaceuticals (Pvt) Ltd
Zantid	Sante (Pvt) Limited
Zita	Gray`S Pharmaceuticals