What is the normal dose of Flexeril (cyclobenzaprine) for a 67-year-old patient with a femoral neck fracture?

Cyclobenzaprine Dosing for a 67-Year-Old Patient with Femoral Neck Fracture

For a 67-year-old patient with a femoral neck fracture, the recommended dose of cyclobenzaprine (Flexeril) is 5 mg three times a day, with careful consideration of reduced dosing frequency due to age.

Appropriate Dosing Considerations

• The FDA-approved dosing for cyclobenzaprine is 5 mg three times daily for most patients, which can be increased to 10 mg three times daily based on individual response 1
• Less frequent dosing should be considered for elderly patients (age 67 falls into this category) due to age-related changes in drug metabolism 1
• Short-term use (two to three weeks maximum) is recommended as cyclobenzaprine is not intended for long-term therapy 1

Age-Specific Considerations

• Elderly patients (≥65 years) are at increased risk for adverse effects from muscle relaxants like cyclobenzaprine due to:
  • Decreased hepatic function affecting drug metabolism 1
  • Increased sensitivity to anticholinergic effects 1
  • Potential for cognitive impairment, which could complicate recovery from femoral neck fracture 1

Special Considerations for Femoral Neck Fracture Patients

• Patients with femoral neck fractures often undergo surgical intervention (hemiarthroplasty or total hip arthroplasty) and require careful medication management 2
• Muscle relaxants may help with post-surgical muscle spasms but must be balanced against risks in elderly patients 2
• Venous thromboembolism (VTE) is a significant concern in hip fracture patients, with prophylaxis strongly recommended 2, 3
• Medication choices should support, not hinder, early mobilization which is critical for recovery 2

Monitoring and Precautions

• Monitor for excessive sedation, which could delay mobilization and increase risk of complications 3
• Be aware of potential drug interactions with other medications commonly used in hip fracture patients, such as anticoagulants for VTE prophylaxis 2, 3
• Assess for signs of anticholinergic side effects (confusion, urinary retention, constipation) which can be particularly problematic in elderly patients 1

Duration of Therapy

• Limit cyclobenzaprine use to the shortest duration necessary (maximum 2-3 weeks) 1
• Consider tapering rather than abrupt discontinuation if used for more than a few days 1
• Evaluate regularly for continued need, especially as the patient transitions to physical therapy and rehabilitation 2

Common Pitfalls to Avoid

• Avoid higher doses (10 mg three times daily) in elderly patients unless absolutely necessary and benefits clearly outweigh risks 1
• Do not use cyclobenzaprine as a primary analgesic; it should complement, not replace, appropriate pain management strategies 2
• Be cautious about combining with opioid analgesics, as this may increase risk of respiratory depression and confusion in elderly patients 2