Serious Abuse Potential

Abstract

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.