Antipsychotic agents (aripiprazole, olanzapine, quetiapine, risperidone, haloperidol, among others) are associated with a 1.7 to 3-fold risk of hospitalisation for pneumonia,[1],[2],[3],[4],[5],[6] and of mortality by pneumonia. As the risk associated with second-generation APs is not lower than that of first-generation agents, sedation and resulting hypoventilation.
The consumption of anticholinergic drugs increases the risk of pneumonia by 1.6 to 2.5-fold.[19],[20],[21]
Opioid analgesics cause respiratory depression with the resulting pulmonary hypoventilation; some of them (codeine, morphine, fentanyl and methadone) have also immunosuppressive effects. They increase the risk of pneumonia and respiratory mortality by 40% to 75%.[26],[27],[28]
Several studies have shown an increase of 20%[34] to 54%[35] in the risk of pneumonia in people consuming hypnotics and sedatives, in particular when they are taken concomitantly with other CNS depressants (e.g., opioids, gabapentinoids).
In a cohort study in more than 130,000 patients , a 15% increase of the risk of respiratory-related morbidity and a 26% increase in mortality was seen among older adults with chronic obstructive pulmonary disease (COPD) exposed to SSRI antidepressants.[38] In other studies, an increase in the risk has been seen in patients exposed to antidepressants concomitantly with other CNS depressants.
In December 2019, the FDA warned about an increased risk of pneumonia and severe respiratory insufficiency and death associated with gabapentinoids, particularly when they are consumed concomitantly with opioid analgesics, hypnotics and sedatives, antidepressants and antihistamines.[40] In 2017 the EMA amended the SPC for gabapentin to include warnings for severe respiratory depression, which may affect up to 1 in 1,000 patients.[41],[42]
Proton pump inhibitors (PPIs, omeprazol and analogues)
The reduction of gastric acidity and the increase in gastric and gut bacterial colonization induced by these drugs can also increase the risk of pneumonia. Two meta-analyses of observational studies have shown increases of 34%[53] to 50%.[54] More recent studies have confirmed this magnitude of risk.[55],[56],[57]
Cancer chemotherapeutic and immunosuppressive agents
Patients on these drugs are more susceptible to viral and non viral infections, and they should generally not abandon the treatment. However, between 20% and 50% of patients with incurable cancer receive chemotherapy within 30 days of death. In terminally ill cancer patients, the use of palliative chemotherapy a few months before death leads to increased risk of undergoing mechanical ventilation and cardiopulmonary resuscitation and dying in an intensive care unit.[63] In the midst of a COVID-19 pandemia, patients, caregivers and oncologists should have a heightened awareness about the potential risks to them and to others of planning and continuing palliative chemotherapy.
Apart from the debate on a possibly increased risk of complications associated to ACE inhibitors and angiotensin receptor blockers (ARBs),[68],[69] a study published in 2012, with 1,039 cases and 2,022 controls, did not find an increased risk of community acquired pneumonia associated to these drugs.[70]
Apart from the debate on a possibly increased risk of complications associated to ACE inhibitors and angiotensin receptor blockers (ARBs),[68],[69] a study published in 2012, with 1,039 cases and 2,022 controls, did not find an increased risk of community acquired pneumonia associated to these drugs.[70]
