Benzodiazepines associated with fatal pneumonia

By medwireNews Reporters

Benzodiazepines are associated with an increased risk for developing pneumonia, as well as an increased risk for dying from pneumonia, research shows.

The results are consistent with existing data from clinical trials and with "concerns expressed over the intensive care unit effects of these drugs leading to movement away from benzodiazepine sedation," according to senior researcher Robert Sanders (University College, London, UK) and colleagues.

As a drug class, benzodiazepines were associated with a significant 54% increased risk for developing pneumonia.

In addition, they were associated with a 22% higher risk for 30-day mortality and a 32% higher risk for long-term mortality in patients with a previous diagnosis of community-acquired pneumonia (CAP).

The results, published in Thorax, were derived from a nested case-control study that included 4964 patients with CAP and 29,697 healthy controls.

In the analysis, all the benzodiazepines, except chlordiazepoxide, were associated with a significantly increased risk for developing pneumonia. Diazepam, lorazepam, and temazepam were associated with a significant 49%, 120%, and 87% increased risk for the disease, respectively.

Zopiclone, which is not a benzodiazepine but acts on GABA receptors, increased the risk for developing pneumonia twofold.

Benzodiazepines as a class also increased the risk for death at 30 days and beyond among patients with a prior diagnosis of CAP.

Each of the benzodiazepines included in the study increased the long-term risk for death, but only diazepam and lorazepam were associated with a significantly increased risk for death at 30 days.

The researchers adjusted for the presence of lung disease in the cases and controls, as well as for prior pneumonia, depression, socioeconomic factors, and other comorbidities.

"Our data indicate a significant risk of benzodiazepine exposure on infectious lung disease which may be considered a modifiable risk factor in future studies," state Sanders and colleagues.

The group stresses that the data cannot be used to link cause and effect, but the results are in line with their hypothesis and preclinical data.

In animal models, benzodiazepines have been shown to increase the risks for infection, while studies in critically ill patients suggest that the drug class increases the risk for infections and sepsis.

Jodi Lindsay (St George's University Of London, UK), who was not involved in the study, called the results "intriguing," and noted that the next steps will involve an attempt to understand the basis of the association between benzodiazepines and pneumonia.

"This could lead to safer anxiety and sedative drugs as well as improving strategies for preventing and treating infections."

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