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Antipsychotic use increases risk for acute respiratory failure in COPD

Antipsychotic use was associated with a dose-dependent increased risk for acute respiratory failure among individuals with chronic obstructive pulmonary disease, according to recent findings.

“In recent decades, there have been reports of 12 patients expressing extreme difficulty breathing, acute respiratory distress, or [acute respiratory failure] requiring intubation or mechanical ventilation within hours and up to approximately 10 days after the use of antipsychotic drugs,” Meng-Ting Wang, PhD, of the National Defense Medical Center, Taipei, Taiwan, and colleagues wrote. “As suggested, inhibition of serotonergic, dopaminergic, and histaminergic receptors by antipsychotics may cause improper respiratory muscle activity or central respiratory depression. Nonetheless, concern about the safety of antipsychotics in patients with [chronic obstructive pulmonary disease] has not been examined via a population-based analysis.”

To assess associations between antipsychotic use and increased risk for acute respiratory failure in individuals with chronic obstructive pulmonary disease (COPD), researchers conducted a population-based case-crossover study of Taiwan National Health Insurance Research data for individuals with COPD (n = 61,620) who were newly diagnosed with acute respiratory failure and required intubation or mechanical ventilation. Antipsychotic use was compared from day 1 to 14, defined as the risk period, with day 75 to 88, defined as the control period.

Overall, 5,032 participants had acute respiratory failure.

During the risk period, 11.1% of individuals with acute respiratory failure filled at least one antipsychotic prescription, compared with 8.8% during the control period. This indicated a 1.66-fold (95% CI, 1.34-2.05; P < .001) adjusted increased risk for acute respiratory failure, regardless of antipsychotic class and administration route.

Researchers found a dose-dependent risk for acute respiratory failure associated with antipsychotics (adjusted OR = 1.35; 95% CI, 1.19-1.52; P < .001), which increased from a 1.52-fold risk for a low daily dose (95% CI, 1.2-1.92; P < .001) to a 3.74-fold risk for a high dose (95% CI, 1.68-8.36; P < .001).

Increased risk for acute respiratory failure was found in a case-time-control analysis (aOR = 1.62; 95% CI, 1.16-2.27; P = .005) and nested case-control study (aOR = 2.16; 95% CI, 1.91-2.15; P < .001).

“We identified a dose-dependent increased risk of [acute respiratory failure] associated with use of antipsychotics in a population of patients with COPD, which rapidly occurred within 2 weeks of initiation of antipsychotic therapy. Further studies are needed to confirm the observed association. Meanwhile, we recommend that health care professionals weigh this risk against the beneficial effects of antipsychotic treatment in patients with COPD,” the researchers concluded. – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.