{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T19:28:29Z","timestamp":1780946909981,"version":"3.54.1"},"reference-count":13,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T00:00:00Z","timestamp":1680048000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Baclofen and tizanidine are both muscle relaxants that carry the risk for neuropsychiatric events in older adults but there is a lack of data directly comparing their safety. This study aimed to investigate the relative risk between these two medications in causing injury and delirium in older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective cohort study that was completed in an integrated healthcare system in the United States and included patients aged 65\u2009years or older who started baclofen or tizanidine for the treatment of musculoskeletal pain from January 2016 through December 2018. Outcomes included new incidence of injury (concussion, contusion, dislocation, fall, fracture, or other injuries) and delirium. The cohort was followed from the initiation of therapy until the first occurrence of any of the following events: end of the index drug exposure, end of health plan membership, death, or the study end date of December 31st, 2019. Descriptive statistics were used to compare baseline patient characteristics between baclofen and tizanidine treatment groups. Cox proportional hazards model was used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The final study cohort included 12,101 and 6,027 older adults in the baclofen and tizanidine group respectively (mean age 72.2\u2009\u00b1\u20096.2\u2009years old, 59% female). Older adults newly started on baclofen had a greater risk of injury (HR\u00a0=\u00a01.54, 95% CI\u00a0=\u00a01.21\u20131.96,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0&lt;\u20090.001) and delirium (HR\u00a0=\u00a03.33, 95% CI\u00a0=\u00a02.11\u20135.26,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0&lt;0.001) compared to those started on tizanidine.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The results of this study suggest that baclofen is associated with higher incidences of injury and delirium compared to tizanidine when used for the treatment of musculoskeletal pain. Future studies should investigate if these risks are dose\u2010related and include a comparison group not exposed to either drug.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.18349","type":"journal-article","created":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T14:47:21Z","timestamp":1680101241000},"page":"2579-2584","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Safety of baclofen versus tizanidine for older adults with musculoskeletal pain"],"prefix":"10.1111","volume":"71","author":[{"given":"Vanessa R.","family":"Su Zhang","sequence":"first","affiliation":[{"name":"Department of Ambulatory Care Pharmacy Kaiser Permanente  San Rafael California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Niu","sequence":"additional","affiliation":[{"name":"Pharmacy Outcomes Research Group Kaiser Permanente  Downey California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric A.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Southern California Permanente Medical Group  West Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"DiStasio","sequence":"additional","affiliation":[{"name":"Department of Neurology Southern California Permanente Medical Group  Harbor City California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3528-3357","authenticated-orcid":false,"given":"Benjamin I.","family":"Broder","sequence":"additional","affiliation":[{"name":"Department of Research &amp; Evaluation Southern California Permanente Medical Group  Pasadena California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven G.","family":"Steinberg","sequence":"additional","affiliation":[{"name":"Department of Family Medicine Southern California Permanente Medical Group  Panorama City California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0014-2431","authenticated-orcid":false,"given":"Rita L.","family":"Hui","sequence":"additional","affiliation":[{"name":"Pharmacy Outcomes Research Group Kaiser Permanente  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,3,29]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2020.05.002"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6736a2"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0178621"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2004.05.002"},{"issue":"4","key":"e_1_2_12_6_1","first-page":"241","article-title":"Tizanidine treatment of spasticity: a meta\u2010analysis of controlled, double\u2010blind, comparative studies with baclofen and diazepam","volume":"15","author":"Groves L","year":"1998","journal-title":"Adv Ther"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15767"},{"key":"e_1_2_12_8_1","unstructured":"KaneSP.The Top 300 of 2021 ClinCalc DrugStats Database Version 21.2. Updated July 3 2021. Accessed August 16 2021.https:\/\/clincalccom\/DrugStats\/Top300Drugsaspx"},{"key":"e_1_2_12_9_1","unstructured":"Baclofen [package insert].U.S. Food and Drug Administration website. Revised September 2019. Accessed August 05 2021.https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2019\/208193s000lbl.pdf"},{"key":"e_1_2_12_10_1","unstructured":"Tizanidine [package insert].U.S. Food and Drug Administration website. Revised November 2013. Accessed August 05 2021.https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2019\/208193s000lbl.pdf"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.17725"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021\u20109681(87)90171\u20108"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17168"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1843"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.18349","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T15:45:30Z","timestamp":1762184730000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.18349"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,29]]},"references-count":13,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1111\/jgs.18349"],"URL":"https:\/\/doi.org\/10.1111\/jgs.18349","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,29]]},"assertion":[{"value":"2022-08-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-03-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-03-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}