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Comparative Risk of Injury with Concurrent Use of Opioids and Skeletal Muscle Relaxants
Cheng Chen1,2, Sean Hennessy1,2,3,4, Colleen M Brensinger1,2
1Center for Real-World Effectiveness and Safety of Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Clinical Pharmacology and Therapeutics
|March 14, 2024
Summary
The risk of injury when combining skeletal muscle relaxants (SMRs) with opioids varies by the specific SMR and opioid. Clinicians should consider these differences when prescribing SMRs to patients using hydrocodone, oxycodone, or tramadol.
Area of Science:
- Pharmacology and Toxicology
- Drug Safety and Pharmacoepidemiology
- Pain Management
Background:
- Concurrent use of skeletal muscle relaxants (SMRs) and opioids is common.
- Previous research suggests an increased risk of injury with combined SMR-opioid use.
- However, specific injury risks associated with different SMRs when combined with opioids remain unclear.
Purpose of the Study:
- To investigate whether injury risks differ among various SMRs when used concurrently with hydrocodone, oxycodone, or tramadol.
- To analyze injury rates based on the initiation order of SMRs and opioids.
Main Methods:
- Retrospective cohort studies utilizing US Medicaid data.
- Analysis of person-time exposed to SMRs and opioids (hydrocodone, oxycodone, tramadol).
- Cox proportional hazard models were used to compare injury rates for different SMRs versus methocarbamol, adjusting for covariates.
Main Results:
- Significant variations in injury rates were observed for specific SMR-opioid combinations and initiation orders.
- For oxycodone, carisoprodol (HR 1.86) and tizanidine (HR 1.73) showed increased injury risks.
- For tramadol, metaxalone (HR 0.69) and tizanidine (HR 0.62) showed decreased injury risks, while baclofen (HR 1.51) and cyclobenzaprine (HR 1.48) showed increased risks.
Conclusions:
- The relative injury risk associated with concurrent SMR and opioid use varies significantly.
- These risks appear dependent on the specific opioid and the sequence of drug initiation.
- Findings suggest clinicians should consider these differential risks when prescribing SMRs to patients on hydrocodone, oxycodone, or tramadol.
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