Increased Aspiration Pneumonia Risk Associated With Antipsychotic Use

The use of antipsychotics in patients hospitalized for non-psychiatric conditions was associated with greater odds for aspiration pneumonia, according to a paper published in the Journal of the American Geriatrics Society.¹

Antipsychotics are commonly used in patients older than 75 admitted to the hospital for non-psychiatric reasons, usually to treat delirium. Despite little evidence for their effectiveness, physicians often have few options and most agree the benefits outweigh the risks.² This large retrospective cohort study of 146,552 adult hospitalizations aimed to reveal the risk between exposure to antipsychotics and aspiration pneumonia.

Hospitalizations at a single institution between January 2007 and July 2013 of patients — not including transfers, admissions shorter than 48 hours, or admissions with psychiatric disorders or psychosis — were included in the study. Median age was 56 (range 18 to 107) and 39% of participants were male. A total of 10,377 patients (7.1%) received antipsychotics. The unadjusted incidence of aspiration pneumonia was higher in patients receiving antipsychotics (odds ratio [OR] 3.9; 95% CI, 3.2-4.8). After adjustment, antipsychotic exposure was significantly associated with aspiration pneumonia (adjusted OR 1.5; 95% CI, 1.2-1.9) and in a propensity matched analysis (adjusted OR 1.4; 95% CI, 1.1-1.8).

Strong associations remained among clinical sub-groups with regard to older age, exposure rate, and discharge diagnosis of delirium or dementia. No associations were found between antipsychotics and non-aspiration pneumonia.

The results suggest that the risks of aspiration pneumonia should be considered before prescribing antipsychotics in the hospital. Future research, however, is required to validate these conclusions at other institutions, and information on preadmission use of antipsychotics should also be included as the inclusion of chronic antipsychotic users in a study might underestimate the risk associated with antipsychotic initiation and aspiration pneumonia. 

References

1. Herzig SJ, LaSalvia MT, Naidus E, et al. Antipsychotics and the risk of aspiration pneumonia in individuals hospitalized for nonpsychiatric conditions: a cohort study [published online November 2, 2017]. J Am Geriatr Soc. doi: 10.1111/jgs.15066
2. Inouye SK, Marcantonio ER, Metzger ED. Doing damage in delirium: The hazards of antipsychotic treatment in elderly persons. Lancet Psychiatry. 2014;1:312-315.