In this case scenario, I lay out a situation where cyclobenzaprine causes confusion. A 76-year-old female has a history of pain issues including RA, back pain, and knee pain. She is currently a resident at a long-term care facility. Her medications include:
- Lisinopril (Podcast Episode) 2.5 mg QD
- Cyclobenzaprine 10 mg TID
- Levothyroxine 25 mcg daily
- Protonix 40 mg QD
- Ibuprofen 200 mg BID
- Citalopram 20 mg QD
- Methotrexate 15 mg Q week
- Folic acid 1 mg QD
Two weeks ago, the primary provider decided to start cyclobenzaprine 10 mg TID for back pain.
In the last 2 weeks, there have been at least 3 episodes of confusion which is rare for this patient. Cyclobenzaprine is highly anticholinergic and on the Beers list as a potentially inappropriate medication to use in geriatric patients. This is likely a contributing factor as cyclobenzaprine causes confusion as an adverse effect and this medication should be at a minimum reduced but likely discontinued. Scheduling acetaminophen or utilizing topical agents would be a couple of options to help deal with the back pain.
Being aware of adverse effects following the initiation of a new medication is crucial for patient safety and effective treatment management. When starting a new drug, healthcare providers should closely monitor for any unexpected symptoms or changes in the patient’s condition. In this case, close monitoring and recognition of a new medication will help prevent this symptom from lingering on indefinitely and/or potentially causing a new diagnosis such as dementia.
The prescribing cascade is a problem due to situations like this scenario of cyclobenzaprine causing confusion. Here are 3 classic examples from the past of the prescribing cascade. Hundreds of these examples can be found in my book Perils of Polypharmacy.
0 Comments