Tolperisone

Quality 0.50 · 0 views · Updated 2 months ago

Skeletal muscle relaxant drug

title: "Tolperisone" type: doc version: 1 created: 2026-02-28 author: "Wikipedia contributors" status: active scope: public tags: ["1-piperidinyl-compounds", "muscle-relaxants", "aromatic-ketones", "calcium-channel-blockers", "sodium-channel-blockers"] description: "Skeletal muscle relaxant drug" topic_path: "general/1-piperidinyl-compounds" source: "https://en.wikipedia.org/wiki/Tolperisone" license: "CC BY-SA 4.0" wikipedia_page_id: 0 wikipedia_revision_id: 0

::summary Skeletal muscle relaxant drug ::

| C=16 | H=23 | N=1 | O=1 | smiles = C1CCCN(C1)CC(C(C2=CC=C(C=C2)C)=O)C | StdInChI_Ref = | StdInChI = 1S/C16H23NO/c1-13-6-8-15(9-7-13)16(18)14(2)12-17-10-4-3-5-11-17/h6-9,14H,3-5,10-12H2,1-2H3 | StdInChIKey_Ref = | StdInChIKey = FSKFPVLPFLJRQB-UHFFFAOYSA-N Tolperisone (trade name Mydocalm among others) is a centrally acting skeletal muscle relaxant used for the treatment of increased muscle tone associated with neurological diseases. It has been used since the 1960s.

Medical uses

Tolperisone is indicated for use in the treatment of pathologically increased tone of the skeletal 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.

Other possible uses include:

Spondylosis
Spondylarthrosis
Cervical and lumbar syndromes
Arthrosis of the large joints
Obliterating atherosclerosis of the extremity vessels (Peripheral arterial disease)
Diabetic angiopathy
Thromboangiitis obliterans
Raynaud's syndrome
Painful reflex muscular spasm, contraction & rigidity
Acrocyanosis
Tension headache

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.

In 2012, following concerns about safety and efficacy, an "article 31 referral" was triggered at the European Medicines Agency (EMA). After the review and a subsequent re-examination, the Agency concluded that the benefits of tolperisone-containing medicines given orally continue to outweigh their risks. However, there is weak support for tolperisone's efficacy, specifically due to the prevalence of hypersensitivity symptoms such as flushing, rash, severe skin itchiness (with raised lumps), wheezing, difficulty breathing and swallowing, fast heartbeat, and fast decrease in blood pressure (basically anaphylaxis). The EMA recommends that tolperisone use be restricted to the treatment of adults with post-stroke spasticity (stiffness). The EMA also advises cessation of advertising, only using tolperisone orally, updating patient information leaflets, and changing to another medicine for existing users.

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. Allergic reactions occur in fewer than 0.1% of patient and include skin rash, hives, Quincke's edema, and in some cases anaphylactic shock.

Overdose

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

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 nonsteroidal anti-inflammatory drugs (NSAIDs) may make a dose reduction necessary in some patients.

Pharmacology

Mechanism of action

Tolperisone is a centrally acting skeletal muscle relaxant that acts at the reticular formation in the brainstem by blocking voltage-gated sodium and calcium channels.

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.

Chemistry

Tolperisone is a piperidine derivative.

Society and culture

Tolperisone was developed in the 1960s in Hungary.

Brand names

Brand names include Biocalm, Miderizone, Mydeton, Mydocalm, Mydoflex, Myolax, Myoxan, Tolson, Topee, and Viveo.

References

(22 June 2012). "Tolperisone - referral {{!}} European Medicines Agency".
(2008-05-14). "Tolperisone: a typical representative of a class of centrally acting muscle relaxants with less sedative side effects". CNS Neuroscience & Therapeutics.
(2007). "Austria-Codex". Österreichischer Apothekerverlag.
"Midocalm". InfoMedic.
(17 September 2018). "Referral procedures".
(17 September 2018). "Tolperisone".
(June 2003). "Anaphylactic reactions to tolperisone (Mydocalm)". [[Swiss Medical Weekly]].
(2003). "[Mydocalm causing anaphylaxis]". Pneumonologia I Alergologia Polska.
(2011). "An immediate hypersensitivity reaction caused by tolperisone hydrochloride". Journal of Investigational Allergology & Clinical Immunology.
(February 2012). "Fatal tolperisone poisoning: autopsy and toxicology findings in three suicide cases". Forensic Science International.
(December 2005). "Tolperisone-type drugs inhibit spinal reflexes via blockade of voltage-gated sodium and calcium channels". The Journal of Pharmacology and Experimental Therapeutics.
(May 2006). "A comparative study of the action of tolperisone on seven different voltage dependent sodium channel isoforms". European Journal of Pharmacology.

::callout[type=info title="Wikipedia Source"] This article was imported from Wikipedia and is available under the Creative Commons Attribution-ShareAlike 4.0 License. Content has been adapted to SurfDoc format. Original contributors can be found on the article history page. ::