Antipsychotic Drug Use and Community-Acquired Pneumonia

Abstract

Antipsychotics are generally distinguished as atypical and typical agents, which are indicated in the treatment of acute and chronic psychoses and other psychiatric disorders. In April 2005, the US Food and Drug Administration issued a warning about the increased risk of all-cause mortality associated with atypical antipsychotic use in elderly patients with dementia. Pneumonia was one of the most frequently reported causes of death. The same warning was extended to typical antipsychotics in June 2008. In recent years, several observational studies have further explored the association between antipsychotic use, mainly in elderly patients, and the risk of fatal/nonfatal community-acquired pneumonia. The aim of this review is to revise and discuss the scientific evidence and biologic explanations for the association between atypical and typical antipsychotic use and pneumonia occurrence. Some general recommendations to clinicians are proposed to prevent the risk of pneumonia in patients requiring antipsychotic treatment.

Association of Proton Pump Inhibitors Usage with Risk of Pneumonia in Dementia Patients

“…Impairment of swallowing and gag reflex after sedation is a possible mechanism. However, there is no clear evidence for an increased risk of pneumonia in younger patients treated with antipsychotics . Moreover, no possible biological explanation for this phenomenon has been suggested.…”

Antipsychotic drug exposure and risk of pneumonia: a systematic review and meta-analysis of observational studies

“…Pneumonia may additionally be associated with use of medicines, including antipsychotic (AP) drugs . In 2005, the U.S. Food and Drug Administration warned of increased mortality, mostly due to pneumonia, in elderly patients with dementia who were treated with second‐generation APs, and in June 2008, the warning was extended to first‐generation AP drugs …”

Current use of second-generation antipsychotics may increase risk of pneumonia in people with schizophrenia

“…Previous work has indicated that clinicians should be vigilant for the occurrence of pneumonia in elderly patients treated with antipsychotics. 1 This study indicates that such vigilance should also apply to younger patients treated with clozapine, particularly during the first month of treatment, and when clozapine is combined with other antipsychotics. Epidemiological studies in other populations are needed to confirm or refute these results, quantify the absolute risk and the influence of other potential risk factors (eg, age, smoking, body weight or physical illness) to help identify higher risk groups.…”

“…1 The study by Kuo and colleagues extends this research to those under 65 years using robust methodology, a nested case-control design in a nationwide cohort of patients who had been admitted with schizophrenia in Taiwan. Prescription claims data provided information on antipsychotic use.…”