Certain Psychiatric Drugs May Raise Pneumonia Risk

Author: Marie Rosenthal MS

Anesthesiology News

A recent meta-analysis indicates that the use of benzodiazepines and benzodiazepine-related drugs (BZRDs) could increase the risk for community-acquired pneumonia (Int J Geriatr Psychiatry 2019 Jan 8. doi: 10.1002/gps.5048. [Epub ahead of print]).

The researchers analyzed 12 reports related to 10 studies that involved more than 120,000 cases of pneumonia and found that the odds for developing pneumonia were 1.25-fold higher (95% CI, 1.09-1.44) in users of BZRDs than in those who had not taken the medications. They also found that the risk decreased with time since last use; current short-acting BZRDs were associated with the highest risk. The risk was modest but statistically significant, they said.

Although widely prescribed and considered relatively safe, they have been associated with numerous adverse events, including falls, fractures, cognitive dysfunction, dementia and behavioral disorder, the researchers said. Now it appears that pneumonia can be added to the list.

Whether or not BZRDs increase the risk for pneumonia had been debated for some time, according to the researchers. Pneumonia is a leading cause of morbidity and mortality in older people—high users of BZRDs—and its incidence has been increasing.

“The precise mechanism of potential risk is unknown, but several biological mechanisms have been proposed to explain a possible relationship between BZRD use and the risk of pneumonia, including suppression of the immune system and relaxation of esophageal sphincter that could increase pneumonia risk. However, whether BZRD therapy is associated with an increased risk of pneumonia is still much debated,” they wrote. Some studies have found a link, but others have not.

• current use (the most recent prescription was filled within 30 days);
• recent use (within 31-90 days); and
• past use (more than 90 days previously).

The investigators identified 3,469 potential articles to review, but narrowed it to 10 studies conducted between 1999 and 2018 that best met all their criteria, covering 120,000 cases of pneumonia. There were six case-control and four cohort studies.

“BZRD use was significantly associated with increased pneumonia in a random effects meta-analysis of all 10 studies ([odds ratio] = 1.25; 95% CI, 1.09-1.44; P<0.001),” the researchers wrote.

“Current or recent exposure to BZRD is associated with an increased pneumonia risk. Clinicians need to weight the benefit-risk balance of BZRD use, especially [for] those with other risk factors for pneumonia,” they wrote. If prescribed BZRDs, patients should be monitored for signs of pneumonia, they suggested.