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Established muscle relaxant offers new approach to managing back pain

A muscle relaxant that has been used for decades outside the UK may provide an alternative to current treatments for low back pain, explains Dr Sunny Nayee, consultant in anaesthesia and pain medicine at Imperial College NHS Healthcare Trust.

Sponsored by Mibe Pharma UK Ltd. UK/MYO/21/044; December 2021.

Click here to view prescribing information for Myopridin® (pridinol mesilate)

An older man in a blue shirt and beige trousers leans forward on a sofa rubbing his painful lower back.
Myopridin (pridinol mesilate) could help address the limitations of current treatments for low back pain. | GETTY IMAGES

Approximately 1 in 6 people in England have back pain.1 Every year in the UK, 2.6 million people with back pain seek advice from their GP, which equates to 7.5 million consultations costing roughly £140.6 million.2,3

Mibe Pharma

Mibe Pharma UK Ltd is a wholly owned subsidiary of Dermapharm based in London. The company’s primary focus is the promotion and distribution of quality branded and generic pharmaceutical products alongside ground-breaking medical devices and supplements into the UK market.

For more information, contact enquiry.mibeUK@dermapharm.com or 020 3870 7503

UK/MYO/21/044; December 2021

This article has been provided by Mibe Pharma UK Ltd for MIMS Connect

There is consensus to suggest that early interventions in the management of low back pain can prevent or significantly reduce chronicity. Myopridin® (pridinol mesilate) is a new treatment option for UK prescribers that could help address the limitations in the current standard of care with the use of NSAIDs, opioids and other muscle relaxants.

Myopridin 3mg tablets are licensed to treat central and peripheral muscle spasms, namely lumbar pain, torticollis and general muscle pain, in adults.4

Pridinol is a centrally acting muscle relaxant that acts via an atropine-like effect on smooth and striated muscles to alleviate skeletal muscle tension of both central and peripheral origin.4 Pridinol has been used for decades in countries such as Germany and Italy. In Germany, pridinol is currently the only muscle relaxant, besides methocarbamol, approved for the treatment of peripheral muscle spasms associated with low back pain.5

Role in practice

Historically in our muscloskeletal MDT pain clinics at Imperial College NHS Healthcare Trust, there has been a lack of pharmacological options for managing acute or acute-on-chronic muscle spasm. Recently, we have seen that local GP use of pridinol has reduced referral rates for non-radicular pain to our clinics.

In my own clinical practice, pridinol is a useful adjunct to physiotherapy in reducing the risk of fear avoidance behaviour. It also allows self-management of motivated patients in the community as it can be used on a prn basis and has no addictive potential.4,6

Myopridin may also support the de-prescribing of other medicines commonly prescribed for low back pain and neck pain, which can be associated with abuse and dependence.7,8

Prescribing pridinol

The recommended dose of pridinol is 1.5–3mg 3 times daily. The treating doctor decides the duration of administration.4

Pridinol relieves muscle tensions more readily the earlier treatment is started.4 Maximum blood concentration is attained within 1 hour, with data highlighting a reduction in observed pain scores within 2 hours of the first dose.4,9

Contraindications to use of pridinol are:4

  • Hypersensitivity to the active substance or to any of the excipients
  • Glaucoma
  • Prostate hypertrophy
  • Syndrome with urinary retention
  • Gastrointestinal obstructions
  • Arrhythmia.

From over 31 million patient treatment days, pridinol has a well-documented safety profile with no known potential for addiction.4, 10–12

Click here to view prescribing information for Myopridin® (pridinol mesilate)

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in Google Play or Apple App Store. Adverse events should also be reported to Mibe Pharma via email at enquiry.mibeUK@dermapharm.com or phone on 0203 870 7503.

References

  1. Versus Arthritis. The state of musculoskeletal health 2021. Accessed 18 November 2021.
  2. National Collaborating Centre for Primary Care. 2009. Low back pain: early management of persistent non-specific low back pain. Accessed 18 November 2021.
  3. Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain 2000; 84: 95–103.
  4. Myopridin Summary of Product Characteristics. Accessed 18 November 2021.
  5. Richter M et al. Pharmacokinetics of oral pridinol: Results of a randomized, crossover bioequivalence trial in healthy subjects. Int J Clin Pharmacol Ther 2021; 59: 471–77.
  6. Pipino F et al. A direct myotonolytic (pridinol mesilate) for the management of chronic low back pain: A multicentre, comparative clinical evaluation. Eur J Clin Res 1991; 1: 55–70.
  7. Gahr M et al. Abuse liability of centrally acting non-opioid analgesics and muscle relaxants - a brief update based on a comparison of pharmacovigilance data and evidence from the literature. Int J Neuropsychopharmacology 2014; 17: 957–9.
  8. NICE. Low back pain and sciatica in over 16s: assessment and management (NG 59), November 2016. Accessed 18 November 2021.
  9. MYTOS (My Therapeutic Observational Study) with Myoson® direct 2005. Data on file.
  10. German usage data. Data on file (KM-01).
  11. Mibe Pharma UK. Communication to MHRA. Data on file (KM-02).
  12. MHRA communication. Data on file (KM-03).

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