Which skeletal muscle relaxant is a Beers Criteria target for avoidance in older adults?

• A. Cyclobenzaprine
• B. Methocarbamol
• C. Carisoprodol
• D. Chlorzoxazone

Answer: (A)

Beers Criteria flags drugs with strong anticholinergic effects and central nervous system (CNS) depression as high risk for older adults, because they raise confusion, delirium, falls, and other adverse effects.

Cyclobenzaprine fits this risk profile most prominently. Its anticholinergic properties and sedating action are particularly problematic in the elderly, who are more susceptible to confusion, cognitive impairment, urinary retention, constipation, and falls due to reduced drug clearance and CNS sensitivity. Because of this, cyclobenzaprine is a clear target for avoidance in older adults.

The other skeletal muscle relaxants listed can still cause drowsiness or dizziness, but they don’t carry the same level of anticholinergic burden that leads to delirium and cognitive problems, so they aren’t singled out for outright avoidance in the Beers Criteria.