Pharmacologic Management of Bruxism in Elderly Patients

First‑Line Pharmacotherapy

Tizanidine is the preferred non‑benzodiazepine agent for elderly individuals requiring medication for bruxism; therapy should be initiated at the lowest available dose and increased gradually to minimize dizziness and somnolence. 1
The American Geriatrics Society designates tizanidine as the only muscle‑relaxant specifically recommended for older adults with musculoskeletal conditions, citing a superior safety profile compared with traditional muscle relaxants. 1
An initial therapeutic trial with tizanidine should not exceed 4–6 weeks; after this period clinicians must reassess goals and adjust dosing as needed. 1

The American Geriatrics Society advises against the use of cyclobenzaprine, methocarbamol, carisoprodol, chlorzoxazone, and metaxalone in older patients because these drugs do not directly relax skeletal muscle, lack efficacy for chronic pain, and carry high anticholinergic and abuse‑related risks. 1
Benzodiazepines are strongly contraindicated during any recovery or rehabilitation phase in elderly patients due to limited analgesic benefit and a high propensity for sedation, falls, and cognitive impairment; this contraindication extends to bruxism management. Evidence from a 2005 Stroke journal review and guideline consensus supports this stance. 2, 1
Routine prescribing of traditional muscle relaxants for bruxism should be avoided, as they provide nonspecific effects and do not achieve true muscle relaxation. 1
Polypharmacy with muscle‑relaxant agents increases fall risk in the elderly and should be minimized. 1

Baclofen may be employed only in refractory bruxism cases and should be started at low doses with close monitoring for dizziness, somnolence, and gastrointestinal symptoms. 1
After prolonged use, baclofen must be tapered slowly to prevent delirium, seizures, and other withdrawal complications. 1

Initiate any selected agent (including tizanidine or baclofen) at the lowest possible dose and increase in small increments while observing for adverse effects. 1
Re‑evaluate therapeutic response and tolerability after a maximum of 4–6 weeks of treatment, adjusting the regimen based on patient‑specific goals. 1

A Cochrane systematic review found insufficient high‑quality evidence for pharmacologic treatment of sleep bruxism, with most trials involving very small sample sizes (7–16 participants) and heterogeneous results. Consequently, guideline panels prioritize agents with favorable safety profiles—such as tizanidine—despite limited bruxism‑specific data. 1