Category: Orthopedics
Posted: 10/11/2025 by Brian Corwell, MD
(Updated: 12/5/2025)
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Use of Muscle Relaxants in the Elderly
A recent pearl discussed the risks of skeletal muscle relaxants (SMR) in the elderly population.
Risks included sedation, confusion, disorientation, orthostatic hypotension and increased risk for falls and fractures.
The Beers Criteria is a list of medications that older adults should generally avoid due to potential adverse effects.
Two commonly used muscle relaxants, Baclofen and Tizanidine (Zanaflex) are not included in the Beers criterion.
A study published last month investigated the safety profile of these medicines as compared to cyclobenzaprine (Flexeril).
Retrospective cohort study of Kaiser Permanente Southern California patients aged 65 to 99 years between 2008 and 2018.
From a population of approximately 88,000 participants (mean age 71.4 years; 59.8% women), approximately 118,000 study medication episodes were identified: 54.8% participants were dispensed baclofen, 6.3% tizanidine, and 38.9% cyclobenzaprine
Outcomes included injury-related hospitalizations, emergency department visits, and urgent care visits documented in EMR and identified through diagnostic codes for fractures, falls leading to fractures, brain injuries, and dislocation injuries
Compared with cyclobenzaprine, Baclofen demonstrated a 69% greater risk (adjusted Hazard Ratio 1.69, [95% CI 1.51-1.88]) and tizanidine carried a 34% greater risk (adjusted Hazard Ratio 1.34, [95% CI 1.11-1.62]) for composite injury outcomes.
Conclusion: Older adult patients prescribed baclofen or tizanidine have an increased risk of injury when compared with Flexeril (currently included on the Beers Criteria)
George MM, et al. Safety of Baclofen and Tizanidine in Older Adults: A Retrospective Cohort Study in a Large Integrated Health Care System. J Am Geriatr Soc. 2025 Sep 13
