Benzodiazepines or related drugs and risk of pneumonia: A systematic review and meta‐analysis

Sun, GuoQing LiBojun HanZhigang; Zhang, Lei; Zhang, Li‐na; Wu, Zhe; Hu, Defeng

doi:10.1002/gps.5048

Cited by 38 publications

(35 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The association between psychotropic drugs and pneumonia in older adults varies between drug groups, and some individual drugs, with the majority of research focusing on antipsychotics and BZDs. Systematic reviews and metaanalyses found increased risk of pneumonia associated with antipsychotic [121] and BZD [126] use, but were not specifically focused on the older adult population. Recent studies focusing on the older and potentially more vulnerable population have supported the findings of these systematic reviews.…”

Section: Discussionmentioning

confidence: 99%

“…The systematic review by Dzahini et al [121] calculated the number needed to harm to be 86 in persons aged 65 years or older based on an incidence of community-acquired pneumonia (CAP) in a study from Spain [162]. Sun et al [126] found a small increase in risk of pneumonia with BZD or BZRD use in their metaanalysis, but the impact on a population level of BZD-or BZRD-associated pneumonia may be substantial given the large number of users. To better treat and reduce adverse drug events, including pneumonia, in this growing older population, prescribers need to be informed of the risk of psychotropic drug use.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review and meta-analysis by Sun et al [126] included eight studies with an older adult study population and found the odds for developing pneumonia in those 65 years or older were 1.29-fold higher in BZD or BZRD users compared with non-users. This relative risk increase was higher than that observed in the general population, but a subgroup analysis found persons aged < 65 years (4 studies included) had a higher risk of pneumonia [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.39-2.34] compared with persons aged 65 years or older.…”

Section: Benzodiazepine and Benzodiazepine-related Drugsmentioning

confidence: 99%

“…This relative risk increase was higher than that observed in the general population, but a subgroup analysis found persons aged < 65 years (4 studies included) had a higher risk of pneumonia [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.39-2.34] compared with persons aged 65 years or older. This review only included studies that compared pneumonia development among people receiving BZDs or BZRDs versus those with no treatment and had high heterogeneity (I 2 = 93.6%) [126]. In three case-control studies, persons with a diagnosis of pneumonia were significantly more likely (OR 1.31-9.3) to have been current users of BZD drugs than those without a pneumonia diagnosis [125,127,128] (Table 2).…”

Section: Benzodiazepine and Benzodiazepine-related Drugsmentioning

confidence: 99%

“…These care guidelines should also be revised when the evidence base develops. Due to the [126] high rate of comorbidities, polypharmacy, communication issues, and non-compliance in the older adult population, prescribers are faced with a difficult task of balancing the benefits and the adverse effects of medications. Even though the AGS Beers criteria and the STOPP/ START criteria do not directly recommend psychotropic drugs be avoided due to the risk of pneumonia, they do list avoidance or for these drugs to be used with caution due to the well documented adverse effects (e.g., sedation) leading to adverse events (e.g., falls), but these same adverse effects could also increase the risk of pneumonia.…”

Section: Therapeutic and Clinical Implicationsmentioning

confidence: 99%

See 4 more Smart Citations

Psychotropic Drug-Associated Pneumonia in Older Adults

2020

View full text Add to dashboard Cite

The use of psychotropic drugs (antipsychotics, benzodiazepines and benzodiazepine-related drugs, and antidepressants) is common, with a prevalence estimates range of 19-29% among community dwelling older adults. These drugs are often prescribed for off-label use, including neuropsychiatric symptoms. The older adult population also has high rates of pneumonia and some of these cases may be associated with adverse drug events. In this narrative review, we summarize the findings from current observational studies on the association between psychotropic drug use and pneumonia in older adults. In addition to studies assessing the use of psychotropics, we included antiepileptic drugs, as they are also central nervous system-acting drugs, whose use is becoming more common in the aging population. The use of antipsychotics, benzodiazepine, and benzodiazepine-related drugs are associated with increased risk of pneumonia in older adults (≥ 65 years of age), and these findings are not limited to this age group. Minimal and conflicting evidence has been reported on the association between antidepressant drug use and pneumonia, but differences between study populations make it difficult to compare findings. Studies regarding antiepileptic drug use and risk of pneumonia in older persons are lacking, although an increased risk of pneumonia in antiepileptic drug users compared with non-users in persons with Alzheimer's disease has been reported. Tools such as the American Geriatric Society Beers Criteria and the STOPP/START criteria for potentially inappropriate medications aids prescribers to avoid these drugs in order to reduce the risk of adverse drug events. However, risk of pneumonia is not mentioned in the current criteria and more research on this topic is needed, especially in vulnerable populations, such as persons with dementia.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Benzodiazepine and Benzodiazepine-related Drugsmentioning

confidence: 99%

Section: Benzodiazepine and Benzodiazepine-related Drugsmentioning

confidence: 99%

Section: Therapeutic and Clinical Implicationsmentioning

confidence: 99%

See 3 more Smart Citations

Psychotropic Drug-Associated Pneumonia in Older Adults

2020

View full text Add to dashboard Cite

show abstract

Safety profile of hypnotics or sedatives on community‐dwelling older adults aged 75 or older in Japan: A retrospective propensity‐matched cohort study

Handa,

Ishizaki,

Mitsutake

et al. 2024

Int J Geriat Psychiatry

View full text Add to dashboard Cite

ObjectiveThe purpose of the study is to assess if daily use of hypnotics increases mortality, aspiration pneumonia and hip fracture among relatively healthy individuals aged 75 years or older who lead independent lives in the community.Method and PatientsOf the adults aged 75 years or older residing in Hokkaido prefecture of Japan (n = 705,538), those who did not meet several exclusion criteria were eligible for generating propensity score‐matched cohorts (n = 214,723). Exclusion criteria included co‐prescribed medications acting on the central nervous system, diagnoses of malignant neoplasm, dementia, depression, etc. We compared 33,095 participants who were prescribed hypnotics for daily use (hypnotic group) with a propensity score‐matched cohort without a prescription (control group). Participants were followed for more than 42 months.ResultsDuring the 42‐month follow‐up period, the incidence of the three outcome measures in the hypnotics group was significantly higher than that in the control group (aspiration pneumonia p < 0.001, hip fracture p = 0.007, and all‐cause mortality p < 0.001). Sensitivity analyses utilizing inverse probability weighting demonstrated hazard ratios of 1.083 [1.023–1.146] for mortality, 1.117 [1.014–1.230] for aspiration pneumonia, and 1.720 [1.559–1.897] for hip fracture. Meanwhile, the attribute risk differences were 2.7, 1.5, and 1.0 per 1000 patient‐years, respectively.ConclusionsAlthough daily use of hypnotics increased the risk of three events, their attribute risk differences were fewer than 3.0 per 1000 patient‐years. The results will help provide guidance on whether it is reasonable to prescribe hypnotics to geriatric population aged 75 or older leading independent lives in the community.Clinical trial registrationUMIN‐CTR UMIN000048398.

show abstract

Phenobarbital versus benzodiazepines in alcohol withdrawal syndrome

Malone,

Costin,

MacElroy

et al. 2023

Neuropsychopharm Rep

View full text Add to dashboard Cite

AimPhenobarbital, a long‐acting barbiturate, presents an alternative to conventional benzodiazepine treatment for alcohol withdrawal syndrome (AWS). Currently, existing research offers only modest guidance on the safety and effectiveness of phenobarbital in managing AWS in hospital settings. The study objective was to assess if a phenobarbital protocol for the treatment of AWS reduces respiratory complications when compared to a more traditionally used benzodiazepine protocol.MethodsA retrospective cohort study analyzing adults who received either phenobarbital or benzodiazepine‐based treatment for AWS over a 4‐year period, 2015–2019, in a community teaching hospital in a large academic medical system.ResultsA total of 147 patient encounters were included (76 phenobarbital and 71 benzodiazepine). Phenobarbital was associated with a significantly decreased risk of respiratory complications, defined by the occurrence of intubation (15/76 phenobarbital [20%] vs. 36/71 benzodiazepine [51%]) and decreased incidence of the requirement of six or greater liters of oxygen when compared with benzodiazepines (10/76 [13%] vs. 28/71 [39%]). There was a significantly higher incidence of pneumonia in benzodiazepine patients (15/76 [20%] vs. 33/71 [47%]). Mode Richmond Agitation Sedation Scale (RASS) scores were more frequently at goal (0 to −1) between 9 and 48 h after the loading dose of study medication for phenobarbital patients. Median hospital and ICU length of stay were significantly shorter for phenobarbital patients when compared with benzodiazepine patients (5 vs. 10 days and 2 vs. 4 days, respectively).ConclusionParenteral phenobarbital loading doses with an oral phenobarbital tapered protocol for AWS resulted in decreased risk of respiratory complications when compared to standard treatment with benzodiazepines.

show abstract

Benzodiazepines or related drugs and risk of pneumonia: A systematic review and meta‐analysis

Cited by 38 publications

References 33 publications

Psychotropic Drug-Associated Pneumonia in Older Adults

Psychotropic Drug-Associated Pneumonia in Older Adults

Safety profile of hypnotics or sedatives on community‐dwelling older adults aged 75 or older in Japan: A retrospective propensity‐matched cohort study

Phenobarbital versus benzodiazepines in alcohol withdrawal syndrome

Contact Info

Product

Resources

About