Utilization of Lower-Dose Cyclobenzaprine in the Older Inpatient

Area of Science:

• Geriatric Medicine
• Clinical Pharmacology
• Hospital Administration

Background:

• Anticholinergic medications, like cyclobenzaprine, pose risks for older inpatients, potentially increasing complications and length of stay (LOS).
• Higher doses of cyclobenzaprine are associated with adverse events such as mental status changes and falls in elderly patients.

Purpose of the Study:

• To evaluate if a lower dose of cyclobenzaprine (5 mg) compared to a higher dose (10 mg) impacts hospital LOS in patients aged 65 and older.
• To assess the effect of cyclobenzaprine dosing on 30-day readmission rates and the requirement for injectable psychotropic agents.

Main Methods:

• Retrospective cohort analysis of inpatients aged 65+ over 2.5 years, comparing outcomes between 5 mg and 10 mg cyclobenzaprine groups.
• Primary outcome: hospital LOS (multivariate linear regression). Secondary outcomes: 30-day readmission rates (logistic regression) and use of injectable antipsychotics/benzodiazepines.
• Sub-analysis examined the impact of a geriatric prescribing context (GEM-CON) on dose selection.

Main Results:

• Patients receiving higher-dose cyclobenzaprine had a significantly longer adjusted hospital LOS (32.7% increase).
• Higher-dose cyclobenzaprine use was significantly associated with increased need for injectable antipsychotics and benzodiazepines.
• No significant association was found between cyclobenzaprine dose and 30-day readmission rates.

Conclusions:

• Lower-dose cyclobenzaprine (5 mg) in older inpatients is linked to reduced hospital LOS.
• Using lower doses of cyclobenzaprine decreases the need for injectable antipsychotics and benzodiazepines in this population.
• Implementation of GEM-CON successfully increased the use of recommended lower cyclobenzaprine doses.