Psychotropic Drug-Associated Pneumonia in Older Adults

Abstract

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.

Postoperative dysphagia caused by a delay in mandibular fracture treatment in a patient with severe intellectual disability: a case report

“…This case report had limitations. That is, we cannot completely rule out the risk of drug-induced dysphagia [ 15 – 17 ] because the patient was under treatment with several antiepileptic and antipsychotic drugs. However, the dose was not changed before and after surgery.…”

First-generation antipsychotics use and reduced risk of pneumonia—Clinical implications in SARS-CoV2 treatment: A systematic review and meta-analysis of observational studies

“…The dopamine receptor blocking activity of FGAs is linked to the extrapyramidal symptoms (EPS) (Farah, 2005). The main EPS related to increased pneumonia risk was tardive dyskinesia (Rajamaki et al, 2020). Affinities of AP for neurotransmitter receptors, particularly the muscarinic-1 (M1) and histaminergic-1 (H1) receptors, may be associated with AP use and pneumonia (Hals et al, 1988).…”

“…SSRI and SNRI may have an adverse effect on the immune cell function and its count, resulting in lower infection threshold, thereby increasing the risk of respiratory depression (Vozoris et al 2018). They also exhibit immunosuppressant effect which increases the risk of pneumonia (Rajamaki et al, 2020).…”

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“…Les posologies les plus élevées, la polymédication et les personnes vulnérables présentent par ailleurs un plus grand risque (risque absolu -sujets âgés, risque relatif -sujets jeunes), pour la plupart des maladies précitées. Les benzodiazépines sont, quant à elles, incriminées pour leurs effets sédatifs, myorelaxants et dépresseurs globaux de l'activité centrale, dans une augmentation du risque de chutes, de fractures associées, d'accidents, de dépressions respiratoires, mais également de pneumonies [9,16].…”

“…Dans un travail de synthèse très récent publié par Rajamaki et al [16], les auteurs rappellent que si l'utilisation des antipsychotiques et des benzodiazépines (et de leurs z-dérivés : zolpidem, zopiclone) est bien associée à un risque accru de pneumonies chez les personnes âgées, les données s'avèrent en l'état insuffisamment nombreuses en ce qui concerne le lien avec les antidépresseurs et les antiépileptiques. Ces données n'intègrent pas d'analyse sur le lithium, mais une étude de 2013 avait fourni des informations rassurantes sur ce versant, démontrant même un effet protecteur apparent, dose-dépendant, de ce traitement sur les pneumonies [35], ces données étant observées chez des patients bipolaires d'un âge médian d'environ 44 ans.…”