Cyclobenzaprine And The Prescribing Cascade
Cyclobenzaprine (podcast episode) is a skeletal muscle relaxant that is most commonly used for muscle spasms and back pain. It definitely has some potential adverse effects that I have seen lead to the prescribing cascade. Here’s a rundown of medications that may help you recognize cyclobenzaprine and the prescribing cascade.
Some of the most common over-the-counter medications that can tip you off for dry mouth (and anticholinergic effects) are saliva substitutes. Oasis and Biotene are two of the common brand names that you may hear patients ask about. When you see patients purchase these or know that patients are using them, be sure to assess the medication list. Cyclobenzaprine is a notorious cause of dry mouth and may lead to the use of saliva substitutes to treat this adverse effect.
CNS adverse effects can happen with the use of cyclobenzaprine. While not crazy common, dizziness is a potential side effect. When assessing for the prescribing cascade, be on the lookout for medications like meclizine that may be used to manage the symptoms of dizziness.
Cyclobenzaprine may worsen mental clarity. In patients who may already be at risk for dementia, this may be a tipping point that leads to the addition of dementia medications. Increasing confusion could lead to the addition of medications like donepezil, rivastigmine, or other acetylcholinesterase inhibitors as well as memantine.
I would say that treating fatigue with medications isn’t incredibly common. It is, unfortunately, something that I have seen. Patients who are fatigued or have a “lack of energy” may be treated with drugs like methylphenidate or modafinil. A drug like cyclobenzaprine can be significantly sedating and cause symptoms of fatigue. Whenever you see medications added to “boost energy” remember to look at the medication list and assess for culprits (like cyclobenzaprine) to the prescribing cascade.
In addition to stimulants, you may see patients try various “energy boosting” supplements. B-vitamins, DHEA, (extra) caffeine, and Co-Q 10 are all examples of supplements that I have seen patients try to help increase their energy. Be sure to review that medication list and ensure that patients aren’t taking a sedating medication like cyclobenzaprine.
Cyclobenzaprine and the prescribing cascade is absolutely real and I have seen it play out in clinical practice. Pay attention to new medications or supplements added to treat potential adverse effects from other medications.
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