Sheng-Yun Cheng1, Wen-Yin Chen1,2, Hsing-Cheng Liu1,3,4, Tien-Wei Yang1,3,4, Chun-Hung Pan1,5, Shu-Yu Yang1,6, Chian-Jue Kuo7,8,9,10. 1. Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan. 2. Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan. 3. Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 4. Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan. 5. Department of Psychology, National Chengchi University, Taipei, Taiwan. 6. Graduate Institute of Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan. 7. Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan. tcpckuo@seed.net.tw. 8. Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. tcpckuo@seed.net.tw. 9. Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan. tcpckuo@seed.net.tw. 10. Department of General Psychiatry, Taipei City Psychiatric Center, 309 Sung-Te Road, Taipei, 110, Taiwan. tcpckuo@seed.net.tw.
Abstract
OBJECTIVES: To investigate the relationship between benzodiazepine and risk of developing pneumonia in patients with schizophrenia, whose benzodiazepine dosage and usage frequency was higher than that of the general population. METHODS: We conducted a nested case-control study to assess the association between benzodiazepine use and pneumonia among patients with schizophrenia. By using the Taiwan National Health Insurance Research Database, we identified a schizophrenia cohort comprising 34,929 patients during 2000-2010. Within the schizophrenia cohort, 2501 cases of pneumonia and 9961 matched control patients (1:4 ratio) were identified. Benzodiazepine exposure was categorized by drug, treatment duration, and daily dose. Conditional logistic regression models were used to examine the association between benzodiazepine exposure and the risk of pneumonia. RESULTS: The current use (within 30 days) of midazolam led to the highest pneumonia risk (adjusted risk ratio = 6.56, P < 0.001), followed by diazepam (3.43, P < 0.001), lorazepam (2.16, P < 0.001), and triazolam (1.80, P = 0.019). Furthermore, nearly all the benzodiazepines under current use had a dose-dependent effect on pneumonia risk. The risk of pneumonia was correlated with the affinities of γ-aminobutyric acid A α1, α2, and α3 receptors. CONCLUSIONS: Benzodiazepines had a dose-dependent relationship with pneumonia in patients with schizophrenia. The differences in risk and mechanism of action of the individual drugs require further investigation. Clinicians should be aware of the early signs of pneumonia in patients with schizophrenia receiving benzodiazepines.
OBJECTIVES: To investigate the relationship between benzodiazepine and risk of developing pneumonia in patients with schizophrenia, whose benzodiazepine dosage and usage frequency was higher than that of the general population. METHODS: We conducted a nested case-control study to assess the association between benzodiazepine use and pneumonia among patients with schizophrenia. By using the Taiwan National Health Insurance Research Database, we identified a schizophrenia cohort comprising 34,929 patients during 2000-2010. Within the schizophrenia cohort, 2501 cases of pneumonia and 9961 matched control patients (1:4 ratio) were identified. Benzodiazepine exposure was categorized by drug, treatment duration, and daily dose. Conditional logistic regression models were used to examine the association between benzodiazepine exposure and the risk of pneumonia. RESULTS: The current use (within 30 days) of midazolam led to the highest pneumonia risk (adjusted risk ratio = 6.56, P < 0.001), followed by diazepam (3.43, P < 0.001), lorazepam (2.16, P < 0.001), and triazolam (1.80, P = 0.019). Furthermore, nearly all the benzodiazepines under current use had a dose-dependent effect on pneumonia risk. The risk of pneumonia was correlated with the affinities of γ-aminobutyric acid A α1, α2, and α3 receptors. CONCLUSIONS:Benzodiazepines had a dose-dependent relationship with pneumonia in patients with schizophrenia. The differences in risk and mechanism of action of the individual drugs require further investigation. Clinicians should be aware of the early signs of pneumonia in patients with schizophrenia receiving benzodiazepines.
Authors: Vassilios Papadopoulos; Mario Baraldi; Tomás R Guilarte; Thomas B Knudsen; Jean-Jacques Lacapère; Peter Lindemann; Michael D Norenberg; David Nutt; Abraham Weizman; Ming-Rong Zhang; Moshe Gavish Journal: Trends Pharmacol Sci Date: 2006-07-05 Impact factor: 14.819
Authors: Anita K Wagner; Fang Zhang; Stephen B Soumerai; Alexander M Walker; Jerry H Gurwitz; Robert J Glynn; Dennis Ross-Degnan Journal: Arch Intern Med Date: 2004-07-26