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orphenadrine

orphenadrine
Brand names: Norflex
Form Strength
SOLUTION, INJECTABLE 60 mg/2 mL
TABLET, EXTENDED RELEASE, ORAL 100 mg
Display Skeletal Muscle Relaxants, Miscellaneous Class: 122092
Medication comments:
2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults.
Medication: orphenadrine (Norflex)
Criteria 1: Potentially inappropriate medication use in older adults. (Table 2)
Drug(s) skeletal muscle relaxants
Rationale Muscle relaxants typically used to treat musculoskeletal complaints are poorly tolerated by older adults due to anticholinergic adverse effects, sedation, and increased risk of fractures; effectiveness at dosages tolerated by older adults is questionable.
This criterion does not apply to skeletal muscle relaxants typically used for the management of spasticity (i.e., baclofen and tiZANidine) although these drugs can also cause substantial adverse effects.
Recommendation Avoid
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Criteria 2: Potentially inappropriate medication use in older adults due to drug–disease or drug–syndrome interactions that may exacerbate the disease or syndrome. (Table 3)
Drug(s) ⇆ disease or syndrome anticholinergics ⇄ Delirium
Rationale Avoid in older adults with or at high risk of delirium because of the potential of inducing or worsening delirium.
Recommendation Avoid
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug(s) ⇆ disease or syndrome anticholinergics ⇄ Dementia or cognitive impairment
Rationale Avoid because of adverse CNS effects. If used, periodic deprescribing attempts should be considered to assess ongoing need and/or the lowest effective dose.
Recommendation Avoid
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug(s) ⇆ disease or syndrome anticholinergics ⇄ History of falls or fractures
Rationale May cause ataxia, impaired psychomotor function, syncope, or additional falls. If one of the drugs must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures. (i.e., anticholinergics, selected antidepressants, antiepileptics, antipsychotics, sedative/hypnotics including benzodiazepines and, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids) and implement other strategies to reduce fall risk.
Recommendation Avoid unless safer alternatives are not available.
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug(s) ⇆ disease or syndrome strongly anticholinergic drugs, except antimuscarinics for urinary incontinence ⇄ Lower urinary tract symptoms, benign prostatic hyperplasia
Rationale May decrease urinary flow and cause urinary retention
Recommendation Avoid in men
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Criteria 4: Potentially clinically important drug-drug interactions that should be avoided in older adults. (Table 5)
Interacting drug(s) or class(es) anticholinergics ⇄ anticholinergics
Risk Rationale Use of more than one medication with anticholinergic properties increases the risk of cognitive decline, delirium, and falls or fractures.
Recommendation Avoid; minimize the number of anticholinergic drugs Click for list.
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Interacting drug(s) or class(es) skeletal muscle relaxants ⇄ CNS-active agents
Risk Rationale Increased risk of falls and of fracture with the concurrent use of ≥3 CNS-active agents (antiepileptics including gabapentinoids, antidepressants, antipsychotics, benzodiazepines, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants).
Recommendation Avoid concurrent use of ≥3 CNS-active drugs Click for list; minimize the number of CNS-active drugs.
 Quality of evidence: High, Strength of Recommendation: Strong
Last updated: Sep. 19, 2025
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