What are the side effects of muscle relaxers for the elderly?

Oct 27, 2025 3 min read •

senior care Healthy Aging Medication Management

According to the American Geriatrics Society (AGS) Beers Criteria, many muscle relaxants are considered potentially inappropriate for older adults. Understanding what are the side effects of muscle relaxers for the elderly is crucial, as seniors are more susceptible to adverse effects like sedation, confusion, and an increased risk of falls.

Quick Summary

Muscle relaxers often cause heightened side effects in older adults due to altered metabolism, increased sensitivity to CNS depressants, and the likelihood of polypharmacy, which can lead to sedation, dizziness, confusion, and a significantly higher risk of falls and injuries.

Key Points

Heightened Risk for Seniors: Older adults metabolize drugs more slowly and are more sensitive to CNS depressants, increasing the intensity and duration of muscle relaxer side effects.
Increased Fall Risk: Sedation, dizziness, and impaired coordination are major side effects that lead to a significantly higher risk of falls and injuries in the elderly.
Cognitive Impairment: Confusion, delirium, and memory problems can occur, especially in those with pre-existing cognitive issues.
Avoidance of Specific Drugs: The Beers Criteria recommends avoiding many muscle relaxants like carisoprodol and cyclobenzaprine in seniors due to their high-risk profiles.
Importance of Non-Pharmacological Alternatives: Physical therapy, gentle stretching, heat, and massage are recommended as safer, first-line treatments for muscle pain in the elderly.
Medical Supervision is Crucial: Due to the complex risks and interactions, a doctor's guidance is essential for any older adult considering muscle relaxer treatment.

Why Muscle Relaxers Pose a Greater Risk for the Elderly

Older adults are more susceptible to the adverse effects of muscle relaxants due to age-related changes in their bodies. Their ability to process medications declines, causing drugs to remain in their system longer and at higher concentrations. The aging central nervous system is also more sensitive to depressants. Taking multiple medications (polypharmacy) is common in older adults, and muscle relaxers can interact with other drugs like pain relievers or antidepressants, intensifying sedative effects. These factors necessitate careful consideration when prescribing muscle relaxants to seniors.

Common and Serious Side Effects

Side effects of muscle relaxers in older adults can range from common to severe.

Central Nervous System Effects

Effects on the brain are particularly concerning for seniors. These include:

Drowsiness and Fatigue: Can interfere with daily activities.
Dizziness and Confusion: May lead to impaired cognitive function, memory problems, and disorientation.
Increased Risk of Falls and Injuries: Dizziness, drowsiness, and poor coordination significantly raise the risk of falls, potentially resulting in fractures or hospitalization. Studies indicate a higher likelihood of fall-related injuries in older adults using muscle relaxants.
Cognitive Impairment: Existing cognitive issues can worsen, and the risk of delirium may increase.

Anticholinergic Effects

Some muscle relaxants, like cyclobenzaprine, have anticholinergic properties that can cause:

Dry Mouth: A frequent side effect that can impact oral health.
Blurred Vision: Can further contribute to fall risk.
Urinary Retention: Especially problematic for older men with prostate issues.
Constipation: Can cause discomfort and potential complications.

Other Potential Side Effects

Gastrointestinal Issues: Nausea and stomach upset are possible.
Cardiovascular Effects: May include rapid heartbeat or low blood pressure.
Addiction and Abuse Potential: Certain muscle relaxants, such as carisoprodol and diazepam, carry risks of dependence and misuse.

Comparative Risks of Different Muscle Relaxers

The risks associated with muscle relaxants vary. The AGS Beers Criteria advises on which medications older adults should avoid. For a comparison of different muscle relaxers, including Cyclobenzaprine (Flexeril), Carisoprodol (Soma), Methocarbamol (Robaxin), and Tizanidine (Zanaflex), and their respective risks and recommendations for elderly patients, see {Link: Dr. Oracle https://www.droracle.ai/articles/102764/best-muscle-relaxant-in-elderly-}. All muscle relaxants should be used with caution in older adults at the lowest effective dose for the shortest possible duration.

Recommendations and Alternatives

Considering the risks, non-pharmacological treatments are often preferred for muscle pain in seniors. These include:

Physical Therapy: Can improve muscle strength and flexibility.
Gentle Stretching and Yoga: Helps alleviate stiffness.
Heat and Massage Therapy: Provides symptomatic relief.
Topical Pain Relief: Offers localized relief with fewer systemic side effects.

Any decision to use a muscle relaxer in an older adult should involve a thorough discussion with a healthcare provider about risks and benefits. Careful monitoring for side effects and keeping dosages low are essential. Patients should be aware of the increased risk of falls and interactions with alcohol or other depressants. For more information on safe medication use for older adults, visit HealthinAging.org, a resource from the American Geriatrics Society.

Conclusion

Muscle relaxers can provide short-term relief, but their use in older adults carries significant risks due to changes in drug metabolism and increased sensitivity to CNS depressants. Side effects like dizziness and confusion raise the risk of falls and injuries. Many muscle relaxants are listed on the Beers Criteria as potentially inappropriate for seniors. Non-pharmacological options are often safer first-line treatments. When used, muscle relaxers in older adults require close medical supervision, careful dosing, and monitoring to minimize risks.

Frequently Asked Questions

Older adults have a slower metabolism and reduced liver and kidney function, which causes medications to build up in their system. This, combined with increased sensitivity to central nervous system depressants, leads to more pronounced side effects like dizziness and sedation.

The most common side effects include drowsiness, dizziness, fatigue, and dry mouth. More serious side effects can include confusion, memory problems, and an increased risk of falls and fractures.

Many common muscle relaxants, such as cyclobenzaprine (Flexeril) and carisoprodol (Soma), are included on the American Geriatrics Society's Beers Criteria list of medications to avoid in older adults due to high risks of falls and cognitive issues.

Yes, absolutely. The sedative effects of muscle relaxers, including drowsiness, dizziness, and impaired coordination, significantly increase the risk of falls and related injuries in older adults.

Non-pharmacological treatments are often the safest and most effective alternatives. These include physical therapy, targeted stretching, massage therapy, and using heat packs for pain relief.

Combining muscle relaxers with other central nervous system depressants like alcohol, sleep aids, or certain pain medications can significantly increase the risk of sedation, confusion, and other dangerous side effects. Always consult a healthcare provider about potential drug interactions.

Muscle relaxers should only be used for the shortest duration necessary, typically 2 to 3 weeks, and at the lowest effective dose. Long-term use is not recommended due to limited evidence of efficacy and increased risks.

Signs of a serious side effect include severe drowsiness, significant confusion, irregular heartbeats, blurred vision, fainting, or issues with urination. These symptoms should be reported to a doctor immediately.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.