Benzodiazepine drugs, such as alprazolam (Xanax) and diazepam (Valium), are linked to an increased risk of pneumonia when given to patients with Alzheimer’s disease, according to a new Finnish study published in CMAJ (Canadian Medical Association Journal).
Alzheimer’s disease, which accounts for 60 to 70 percent of cases of dementia, is already a risk factor for pneumonia on its own, and many people with dementia are prescribed benzodiazepines and non-benzodiazepines, called Z-drugs, both of which have sedative effects.
“An increased risk of pneumonia is an important finding to consider in treatment of patients with Alzheimer disease,” writes Dr. Heidi Taipale of the Kuopio Research Centre of Geriatric Care at the University of Eastern Finland, with coauthors.
“Benzodiazepines and Z-drugs are frequently prescribed for this population, and long-term use is typical. Pneumonia often leads to admission to hospital, and patients with dementia are at increased risk of death related to pneumonia.”
For the study, researchers looked at data from national registries on 49,484 adults living in the community diagnosed with Alzheimer disease between 2005 and 2011 in Finland. The mean age of participants was 80 years and almost two-thirds (62.7 percent) were women. They matched 5,232 patients taking benzodiazepines and 3,269 patients taking Z-drugs with a control group not taking either drug.
The findings show that benzodiazepines were linked to a 30 percent increased risk of pneumonia in patients with Alzheimer disease, and the risk was highest at the start of treatment (during the first 30 days).
Although the association with Z-drug use and pneumonia was not statistically significant, the authors cannot conclude these drugs are safer as the study did not directly compare Z-drugs and benzodiazepines.
The researchers suggest that the sedative nature of benzodiazepines may lead to a greater risk of pneumonia by increasing the aspiration of saliva or food into the lungs. The results are similar to other studies showing an increased risk of pneumonia in patients of all ages taking benzodiazepines.
“Benefits and risks of the use of benzodiazepines should be carefully considered for patients with Alzheimer disease and include risk of pneumonia,” the authors conclude.
In a related commentary, Dr. Paula Rochon from Women’s College Hospital and the University of Toronto, with coauthors, writes this study “is a good reminder to clinicians to ‘first do no harm’ when prescribing these drugs for frail older women and men with dementia.
“Nonpharmacologic approaches should be the starting point when managing neuropsychiatric symptoms in this patient population, which should help to limit inappropriate use of these drugs.”