Second-Generation Antipsychotic Medications and Risk of Pneumonia in Schizophrenia

Abstract

This study assessed the association between second-generation antipsychotic medications and risk of pneumonia requiring hospitalization in patients with schizophrenia because the evidence is limited in the population. We enrolled a nationwide cohort of 33,024 inpatients with schizophrenia ranged in age from 18 to 65 years, who were derived from the National Health Insurance Research Database in Taiwan from 2000 to 2008. Cases (n = 1741) were defined as patients who developed pneumonia after their first psychiatric admissions. Risk set sampling was used to match each case with 4 controls by age, sex, and the year of the first admission based on nested case-control study. Antipsychotic exposure was categorized by type, duration, and daily dose, and the association between exposure and pneumonia was assessed using conditional logistic regression. We found that current use of clozapine (adjusted risk ratio = 3.18, 95% CI: 2.62-3.86, P < .001) was associated with a dose-dependent increase in the risk. Although quetiapine, olanzapine, zotepine, and risperidone were associated with increased risk, there was no clear dose-dependent relationship. Amisulpride was associated with a low risk of pneumonia. The use of clozapine combined with another drug (olanzapine, quetiapine, zotepine, risperidone, or amisulpride), as assessed separately, was associated with increased risk for pneumonia. In addition, with the exception of amisulpride, each drug was associated with increased risk for pneumonia at the beginning of treatment. Clinicians who prescribe clozapine to patients with schizophrenia should closely monitor them for pneumonia, particularly at the start of therapy and when clozapine is combined with other antipsychotics.

Acute exacerbation of psychiatric symptoms during influenza treatment with oseltamivir in chronic schizophrenia

“…18 Clozapine, quetiapine, olanzapine, zotepine, and risperidone have been associated with an increased risk of pneumonia in schizophrenia patients from a nested caseecontrol study utilizing Taiwan's National Health Insurance Research Database. 19 This is one of the reasons we tapered down the antipsychotics. The other reasons were to prevent oversedation and aspiration related to extrapyramidal side effects or clozapine-induced sialorrhea.…”

Systematic Literature Review of the Methods Used to Compare Newer Second-Generation Agents for the Management of Schizophrenia: A focus on Health Technology Assessment

“…A single case-control study was included in our review [198]. This study examined the association between various antipsychotics (olanzapine, risperidone, quetiapine, zotepine, amisulpride, and clozapine) and the risk of pneumonia.…”

Antipsychotic use in elderly patients and the risk of pneumonia

“…Receptor affinities for histaminergic and muscarinic are considered the most plausible explanation for the association seen with antipsychotics in such cohorts. To further support this biological mechanism, it is a consistent finding that the concomitant use of more than one antipsychotic drug is far more dangerous [15,16].…”

“…It should be noted, however, that in most of the observational studies there were insufficient information about the severity of the underlying condition and inconsistent data regarding comorbidities [14]. Nonetheless, the use of antipsychotics has been linked to an increased risk of pneumonia also in large nationwide cohorts of much younger patients affected by schizophrenia, and by bipolar disorder with a substantially lower burden of comorbid conditions [15,16]. In these patients, lithium and other mood stabilizers are not associated with the risk of pneumonia.…”