Provider Briefing: Tizanidine Availability in 2026

Tizanidine remains one of the most commonly prescribed antispasticity agents in the United States, with use extending well beyond its FDA-approved indications for spasticity into off-label applications for chronic pain, migraine, and musculoskeletal conditions. If your patients are reporting difficulty filling Tizanidine prescriptions, this briefing provides the current landscape and actionable guidance.

Current Shortage Status

As of February 2026, Tizanidine is not listed on the FDA Drug Shortage database or the ASHP drug shortage list. There is no formal, manufacturer-reported shortage. However, clinicians and patients across the country continue to encounter intermittent, localized stock-outs — particularly for the 4 mg tablet and 6 mg capsule formulations.

This discrepancy between official shortage status and real-world availability is a familiar pattern in the generic drug market. Multiple manufacturers produce Tizanidine, but thin margins, distributor allocation practices, and supply chain fragility create pockets of unavailability that don't rise to the level of an FDA-reported shortage.

Timeline and Context

Tizanidine has not experienced a major, sustained nationwide shortage in recent years. The current availability challenges reflect broader trends affecting generic medications:

• 2023-2024: Industry-wide generic drug supply chain pressures, driven by raw material sourcing disruptions and quality compliance issues at overseas manufacturing facilities.
• 2025: Gradual stabilization for most generic muscle relaxants, though intermittent spot shortages persisted at the pharmacy level.
• 2026: No formal shortage, but continued reports of localized difficulty, particularly at high-volume chain pharmacies with automated inventory systems that may understock less frequently dispensed strengths.

Prescribing Implications

The availability picture has several practical implications for prescribers:

Formulation Considerations

Tizanidine is available in both tablet and capsule formulations, and it's important to note that these are not bioequivalent. Capsules taken with food have significantly higher bioavailability than tablets. If you're switching a patient between formulations due to availability, dose adjustments and monitoring may be warranted.

• Tablets: 2 mg, 4 mg
• Capsules: 2 mg, 4 mg, 6 mg

CYP1A2 Interaction Profile

Tizanidine is extensively metabolized by CYP1A2, and this interaction profile should be top of mind when considering alternatives or managing patients who can't access their usual supply:

• Contraindicated: Concomitant use with strong CYP1A2 inhibitors — ciprofloxacin and fluvoxamine — is contraindicated due to risk of severe hypotension and excessive sedation (up to 10-fold increase in AUC).
• Use caution: Moderate CYP1A2 inhibitors including oral contraceptives (ethinyl estradiol), zileuton, acyclovir, and cimetidine.
• Withdrawal risk: Patients on higher doses (20-36 mg/day) or those who have used Tizanidine for more than 9 weeks require gradual tapering (2-4 mg/day reductions) to avoid rebound hypertension and tachycardia.

For a comprehensive review of Tizanidine's interaction profile, see our drug interactions guide.

Availability Picture

The current availability landscape:

• Generic Tizanidine: Manufactured by multiple companies (Teva, Sandoz, Amneal, and others). Overall national supply is adequate, but distribution is uneven.
• Brand Zanaflex: No longer actively marketed by most sources; generic is the standard.
• Chain pharmacies: Most likely to experience stock-outs due to automated inventory management and distributor allocation limits.
• Independent pharmacies: Often have greater flexibility in sourcing and may be more reliably stocked.
• Mail-order pharmacies: Generally maintain more consistent inventory for established generic medications.

Cost and Access Considerations

Tizanidine remains affordable as a generic medication, which helps with patient adherence:

• Cash price: $15-$50 for a 30-day supply
• With discount cards: $4-$10/month (GoodRx, SingleCare)
• Insurance: Typically Tier 1 or Tier 2 on most formularies; prior authorization is rarely required for generic
• Patient assistance: Available through NeedyMeds and RxAssist for uninsured or underinsured patients

Cost is generally not the barrier — availability is. Direct patients who are having trouble to Medfinder for Providers for real-time stock checking tools.

Tools and Resources for Your Practice

Several resources can help you and your patients navigate availability challenges:

• Medfinder for Providers: Real-time pharmacy stock availability, helping your staff direct patients to pharmacies with confirmed Tizanidine supply.
• FDA Drug Shortage Database: Official shortage tracking at accessdata.fda.gov
• ASHP Drug Shortage Resource Center: Clinical guidance and alternative therapy recommendations during shortages.
• Prescribing flexibility: Consider writing prescriptions that allow pharmacist substitution between tablet and capsule formulations (with appropriate dose adjustment guidance) to maximize fillability.

Alternative Agents

When Tizanidine is unavailable or contraindicated, the primary alternatives for spasticity management include:

• Baclofen: GABA-B agonist; most comparable efficacy for spasticity; available oral and intrathecal
• Cyclobenzaprine: Better suited for acute musculoskeletal spasm than neurological spasticity
• Dantrolene: Direct-acting skeletal muscle relaxant; hepatotoxicity risk requires monitoring
• Methocarbamol: Less sedating but generally less effective for spasticity

See our clinical overview: alternatives to Tizanidine.

Looking Ahead

No new formulations or significant market changes for Tizanidine are anticipated in 2026. The generic manufacturing base remains stable with multiple producers. The ongoing challenges are structural — related to generic drug economics and distribution — rather than specific to Tizanidine production.

Continued vigilance in prescription management and patient communication remains the best approach. Educating patients to refill proactively and use availability-checking tools can prevent gaps in therapy.

Final Thoughts

Tizanidine's availability in 2026 is adequate at the national level but inconsistent at the pharmacy level. The clinical implications are manageable with proactive prescribing practices, patient education, and awareness of formulation differences. For a patient-facing version of this update, share our patient shortage guide with your patients.

For provider-specific tools and resources, visit medfinder.com/providers.