This review examines literature on the efficacy and abuse potential of carisoprodol, makes recommendations for use of this agent in the hospital setting, and outlines applicable federal and state regulations. A Medline search using key words and MeSH terms was conducted. In addition, International Pharmaceutical Abstracts (1970–2002), Current Contents (1996–2002), Cochrane Database of Systematic Reviews (1999–2002), and Psych Info (1872–2002) were searched for relevant literature. Articles cited in the bibliographies produced by these searches were included in the review. A Web of Science search was conducted for all citations found in all the searches. Pain is a common physical symptom in patients with musculoskeletal problems, and pharmacologic therapy is often combined with nonpharmacologic measures to treat the pain etiology and symptomatology. Skeletal muscle relaxants (SMRs) and nonsteroidal anti-inflammatory drugs (NSAIDs) represent the most common drug therapy choices in patients with mild-to-moderate somatic pain. Carisoprodol (Soma) is an SMR that has a poorly defined mechanism of action and a high potential for abuse. This literature review produced little evidence to support the use of carisoprodol in pain control. The research also showed that patients with a history of previous substance abuse are more likely to abuse this drug; thus carisoprodol does not meet safety and efficacy standards and should be removed from the market. At the very least, states should reschedule carisoprodol as a schedule IV controlled substance to minimize chronic misuse and abuse. If carisprodol is listed in hospital formularies, it should be handled as a controlled substance regardless of its federal status. Alternative sedatives (eg, phenobarbital) should be used to manage patients experiencing carisoprodol withdrawal symptoms.
CarringtonJ., GetterL., BrownR.S.Diabetic neuropathy masquerading as glossodynia. J Am Dent Assoc.2001; 132(11): 1549–51.
2.
StohlerC.S.Chronic orofacial pain: Is the puzzle unraveling?J Dent Educ.2001; 65(12): 1383–92.
3.
CapewellS., McMurrayJ.“Chest pain–please admit”: Is there an alternative?BMJ.2000; 320: 951–2.
4.
Pain Assessment and Management: An Organizational Approach.Oakbrook Park, IL: Joint Commission on Accreditation of Healthcare Organizations (JCAHO); 2000, 13–32.
5.
Acute Pain Management Guideline Panel.Acute Pain Management: Operative of Medical Procedures and Trauma. Clinical Practice Guideline [AHCPR Pub. No. 92–0032]. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services; February, 1992.
6.
American Pain Society.Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. 4th ed. http://www.ampainsoc.org. Accessed January 9, 2002.
7.
LittrellR.A., HayesL.R., StillnerV.Carisoprodol (Soma): A new and cautious perspective on an old agent. South Med J.1993; 86(7): 753–68.
BrocksD.R.Anticholinergic drugs used in Parkinson's disease: An overlooked class of drugs from a pharmacokinetic perspective. J Pharm Pharma Sci.1999; 2(2): 39–46.
14.
SchifanoF., MarraR., MagniG.Orphenadrine abuse [letter]. South Med J.1988; 81: 546–7.
15.
DalenP., AlvanG., WakelkampM.Formation of meprobamate from carisoprodol is catalyzed by CYP2C19. Pharmacogenetics.1996; 6: 387–94.
16.
OlsenH., KoppangE., AlvanG.Carisoprodol elimination in humans. Ther Drug Monit.1994; 16: 337–40.
17.
NordengH., ZahlsenK., SpigsetO.Transfer of carisoprodol to breast milk. Ther Drug Monit.2001; 23: 298–300.
18.
BackerR.C., ZumwaktR., McFeeleyP.Carisoprodol concentrations from different anatomical sites: Three overdose cases. J Anal Toxicol.1990; 14: 332–4.
RustG.S., HatchR., GumsJ.G.Carisoprodol as a drug of abuse. Arch Fam Med.1993; 2(4): 429–32.
23.
LittrellR.A., SageT., MillerW.Meprobamate dependence secondary to carisoprodol (Soma) use. Am J Drug Alcohol Abuse.1993; 19(1): 133–4.
24.
LuehrJ.G., MeyerleK.A., LarsonE.W.Mail-order (veterinary) drug dependence. JAMA.1990; 263(5): 657.
25.
OlsenH., KoppangE., AlvanG.Carisoprodol elimination in humans. Ther Drug Monit.1994; 16(4): 337–40.
26.
RoacheJ.D., GriffithsR.R.Lorazepam and meprobamate dose effects in humans: Behavioral effects and abuse liability. J Pharmacol Exp Ther.1987; 243(3): 978–88.
27.
BarattaR.R.A double-blind comparative study of carisoprodol, propoxyphene, and placebo in the management of low back syndrome. Curr Ther Res.1976; 20(3): 233–40.
28.
CullenA.P.Carisoprodol (Soma) in acute back conditions: A double blind, randomized, placebo controlled study. Curr Ther Res Clin Exp.1976; 20: 557–62.
29.
GallardoF., MolgoJ., MiyazakiC.Carisoprodol in the treatment of myofascial pain-dysfunction syndrome. J Oral Surg.1975; 33(9): 655–8.
30.
MillerA.R.Comparative study of Parafon Forte tablets and Soma Compound in the treatment of painful skeletal muscle conditions. Curr Ther Res Clin Exp.1976; 19: 444–50.
31.
HindleT.H.Comparison of carisoprodol, butabarbital, and placebo in treatment of the low back syndrome. Calif Med.1972; 117: 7–11.
32.
RollingsH.E., GlassmanJ.M., SoykaJ.P.Management of acute musculoskeletal conditions — thoracolumbar strain or sprain: A double-blind evaluation comparing the efficacy and safety of carisoprodol with cyclobenzaprine hydrochloride. Curr Ther Res.1983; 34: 917–28.
33.
VaeroyH., AbrahamsenA., ForreO.Treatment of fibromyalgia (fibrositis syndrome): A parallel double-blind trial with carisoprodol, paracetamol and caffeine (Somadril comp) vs placebo. Clin Rheumatol.1989; 8(2): 245–50.
34.
SnellW., CorriganR.F., ZimermanR.C.Comparative drug evaluation in treatment of skeletal muscle spasm. Clin Med.1965; 72: 957–72.
35.
CooperC.D.Comparative effects of diazepam, chlormezanone, and carisoprodol in musculoskeletal disorders. West J Med.1963; 4: 34–9.
SikdarS., BasuD., MalhotraA.K.Carisoprodol abuse: A report from India. Acta Psychiatr Scand.1993; 88(4): 302–3.
47.
WyllerT.B., KorsmoG., GadeholtG.Dependence on carisoprodol (Somadril)? A prospective withdrawal study among prisoners. Tidsskr Nor Laegeforen.1991; 111(2): 193–5.
48.
DoughertyR.J.Carisoprodol should be a controlled substance. Arch Fam Med.1995; 4: 582.
49.
UkensC.Carisoprodol abuse on rise, warns Mississippi Board. Drug Topics.1992; 19.
50.
United States of America Department of Health and Human Services, Public Health Service Food and Drug Administration, Center for Drug Evaluation and Research. Drug Abuse Advisory Committee Meeting. February 11, 1997. http://www.fda.gov/ohrms/dockets/ac/97/transcpt/3316t1.pdf. Accessed March 25, 2002.
51.
Regulatory Update.Carisoprodol Addiction Studies Requested. ASAM News.1997; 12(4): 1–2. http://www.asam.org/news/news10.htm. Accessed March 25, 2002.
52.
National Institute on Drug Abuse Statistical Series.Data from the Drug Abuse Warning Network (DAWN), 2000.Rockville, MD: US Department of Health and Human Services. www.samsha.gov/statistics/statistics.html. Accessed March 25, 2002.
53.
Epidemiologic Trends in Drug Abuse. Volume 1: Highlights and Executive Summary. June 2001. CEWG: Community Epidemiology Work Group. National Institute of Drug Abuse. National Institute of Health. http://165.112.78.61/CEWG/volumes/EXSUMJune01.pdf. Accessed March 25, 2002.
http://www.247-pharmacy.com/Mio_Relax.htm. General information about Soma; advertises that one can order Soma without a prescription and without consultation fees. Accessed November 20, 2002.
http://www.overseasdrugstore.com/. Overseas prescriptions when prescribing doctor is listed for contact information. Accessed November 20, 2002.
67.
AMA, JCAHO, and NCQA to Focus on Measuring the Effectiveness of Appropriate Pain Management. http://www.jcaho.org/news/nb350.html. Accessed March 25, 2002.
68.
VeithJ.L., AndersonJ., SladeS.A.Plasma beta-endorphin, pain thresholds and anxiety levels across the human menstrual cycle. Physiol Behav.1984; 32(1): 31–4.
69.
ShermanR.A., GallN., GormlyJ.Treatment of phantom limb pain with muscular relaxation training to disrupt the pain-anxiety tension cycle. Pain.1979; 6(1): 47–55.
70.
LipitzJ.S., MalangaG.A.Oral medications in the treatment of acute low back pain. Occup Med.1998; 13: 151–66.
71.
WessonD.R., SmithD.E., LingW.Sedative-hypnotics and tricyclics: Phenobarbital for carisoprodol withdrawal. In LowinsonJ.H., RuizP., MillmanR.B.., eds. Substance Abuse: A Comprehensive Textbook.3rd ed.Baltimore: William and Wilkins; 1997, 223–8.
