Antipsychotic use in elderly patients and the risk of pneumonia

Gambassi, Giovanni; Sultana, Janet; Trifirò, Gianluca

doi:10.1517/14740338.2015.984684

Cited by 32 publications

(25 citation statements)

References 16 publications

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“…Seven articles were subsequently excluded because they were not in English or had no full text available, even after the authors were contacted (see S1 Table for details on excluded studies with no full text). Forty-one articles were included in the final assessment and of these, the majority were observational studies (N = 16) [ 1 , 4 , 6 – 10 , 12 , 13 , 18 , 25 – 29 , 35 – 46 ]. Of the 41 articles included, 30 hypothesized a mechanism of action.…”

Section: Resultsmentioning

confidence: 99%

“…The biological pathways underlying antipsychotic-induced pneumonia are not currently known, although several plausible hypotheses have been postulated [ 18 ]. Understanding which drugs are associated with the highest risk of pneumonia would allow prescribers to select drugs with a lower risk of pneumonia in persons with risk factors predisposing them to infectious respiratory diseases.…”

Section: Introductionmentioning

confidence: 99%

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Biological substantiation of antipsychotic-associated pneumonia: Systematic literature review and computational analyses

et al. 2017

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IntroductionAntipsychotic (AP) safety has been widely investigated. However, mechanisms underlying AP-associated pneumonia are not well-defined.AimThe aim of this study was to investigate the known mechanisms of AP-associated pneumonia through a systematic literature review, confirm these mechanisms using an independent data source on drug targets and attempt to identify novel AP drug targets potentially linked to pneumonia.MethodsA search was conducted in Medline and Web of Science to identify studies exploring the association between pneumonia and antipsychotic use, from which information on hypothesized mechanism of action was extracted. All studies had to be in English and had to concern AP use as an intervention in persons of any age and for any indication, provided that the outcome was pneumonia. Information on the study design, population, exposure, outcome, risk estimate and mechanism of action was tabulated. Public repositories of pharmacology and drug safety data were used to identify the receptor binding profile and AP safety events. Cytoscape was then used to map biological pathways that could link AP targets and off-targets to pneumonia.ResultsThe literature search yielded 200 articles; 41 were included in the review. Thirty studies reported a hypothesized mechanism of action, most commonly activation/inhibition of cholinergic, histaminergic and dopaminergic receptors. In vitro pharmacology data confirmed receptor affinities identified in the literature review. Two targets, thromboxane A2 receptor (TBXA2R) and platelet activating factor receptor (PTAFR) were found to be novel AP target receptors potentially associated with pneumonia. Biological pathways constructed using Cytoscape identified plausible biological links potentially leading to pneumonia downstream of TBXA2R and PTAFR.ConclusionInnovative approaches for biological substantiation of drug-adverse event associations may strengthen evidence on drug safety profiles and help to tailor pharmacological therapies to patient risk factors.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Biological substantiation of antipsychotic-associated pneumonia: Systematic literature review and computational analyses

et al. 2017

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“…This has been associated with sialorrhea 131–133. There is evidence suggesting that this risk is dose related, in particular with CLO, and is higher in the first weeks of therapy and in elderly patients 132,134. Polypharmacotherapy may further increase pneumonia risk 132.…”

Section: Methodsmentioning

confidence: 99%

Safety, tolerability, and risks associated with first- and second-generation antipsychotics: a state-of-the-art clinical review

Solmi

Murru

Pacchiarotti

et al. 2017

TCRM

339

244

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Since the discovery of chlorpromazine (CPZ) in 1952, first-generation antipsychotics (FGAs) have revolutionized psychiatric care in terms of facilitating discharge from hospital and enabling large numbers of patients with severe mental illness (SMI) to be treated in the community. Second-generation antipsychotics (SGAs) ushered in a progressive shift from the paternalistic management of SMI symptoms to a patient-centered approach, which emphasized targets important to patients – psychosocial functioning, quality of life, and recovery. These drugs are no longer limited to specific Diagnostic and Statistical Manual of Mental Disorders (DSM) categories. Evidence indicates that SGAs show an improved safety and tolerability profile compared with FGAs. The incidence of treatment-emergent extrapyramidal side effects is lower, and there is less impairment of cognitive function and treatment-related negative symptoms. However, treatment with SGAs has been associated with a wide range of untoward effects, among which treatment-emergent weight gain and metabolic abnormalities are of notable concern. The present clinical review aims to summarize the safety and tolerability profile of selected FGAs and SGAs and to link treatment-related adverse effects to the pharmacodynamic profile of each drug. Evidence, predominantly derived from systematic reviews, meta-analyses, and clinical trials of the drugs amisulpride, aripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, sertindole, ziprasidone, CPZ, haloperidol, loxapine, and perphenazine, is summarized. In addition, the safety and tolerability profiles of antipsychotics are discussed in the context of the “behavioral toxicity” conceptual framework, which considers the longitudinal course and the clinical and therapeutic consequences of treatment-emergent side effects. In SMI, SGAs with safer metabolic profiles should ideally be prescribed first. However, alongside with safety, efficacy should also be considered on a patient-tailored basis.

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“…There are multifactorial pathways in which antipsychotics can lead to pneumonia. Antipsychotics affect dopamine D 2 , cholinergic, and histamine-1 receptors, which can lead to extrapyramidal adverse effects, dysphagia, and sedation [133][134][135]. Extrapyramidal symptoms (EPS) are more common with FGAs than SGAs and these symptoms may impair swallowing.…”

Section: Antipsychoticsmentioning

confidence: 99%

Psychotropic Drug-Associated Pneumonia in Older Adults

2020

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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.

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Antipsychotic use in elderly patients and the risk of pneumonia

Cited by 32 publications

References 16 publications

Biological substantiation of antipsychotic-associated pneumonia: Systematic literature review and computational analyses

Biological substantiation of antipsychotic-associated pneumonia: Systematic literature review and computational analyses

Safety, tolerability, and risks associated with first- and second-generation antipsychotics: a state-of-the-art clinical review

Psychotropic Drug-Associated Pneumonia in Older Adults

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