Antipsychotics Tied to Respiratory Failure in At-Risk Patients

Association Between Antipsychotic Agents and Risk of Acute Respiratory Failure in Patients With Chronic Obstructive Pulmonary Disease

Megan Brooks

January 12, 2017

Antipsychotics have been linked to respiratory failure in a dose-dependent manner among patients with chronic obstructive pulmonary disease (COPD), results of a large observational study show.

“Multiple cases about acute respiratory distress or acute respiratory failure [ARF] from the use of antipsychotics have been reported during the past decades. Nevertheless, no population-based studies have been conducted to examine this potential drug safety issue,” study investigator Meng-Ting Wang, PhD, of the National Defense Medical Center in Taipei, Taiwan, told Medscape Medical News.

“Clinicians should exercise caution when prescribing antipsychotics to patients with COPD and avoid high doses if possible,” the investigators write.

The study was published online January 4 in JAMA Psychiatry.

Dose-Dependent Relationship 

The researchers analyzed healthcare claims records in the Taiwan National Health Insurance Database and antipsychotic medication history for 5032 patients with COPD who developed incident and idiopathic ARF (excluding cardiogenic, traumatic, and septic causes).

Using a case-crossover study design, they compared antipsychotic use during the 2 weeks before the ARF event (case period) and an earlier control period 2 to 3 months before the ARF event.

A total of 590 (11.7%) patients with ARF filled at least one antipsychotic prescription during the case period, compared with 443 (8.8%) during the control period. This corresponds to a 1.66-fold (95% confidence interval [CI], 1.34 – 2.05; P < .001) adjusted increased risk for ARF, regardless of antipsychotic class and route of administration.

The risk for ARF with antipsychotic use was dose-dependent, increasing from a 1.52-fold risk for a low defined daily dose (DDD) of 0.25 or less to a 3.74-fold risk for a high DDD of 1 or more.

“Overall, this is the first population-based observational study that reports a dose-dependent acute effect of antipsychotic use on risk of ARF,” said Dr Wang.

The findings, he added, have important implications for the management of COPD patients.

“First, we urge healthcare professionals to be vigilant about the development of ARF in COPD patients receiving antipsychotic treatment, especially during the initial phase of treatment,” he said.

“Second, antipsychotic use in COPD patients needs to be justified, given we noticed a high proportion of off-label use in our population. Third, according to our dose analysis, high daily dose of antipsychotics with more than 1 DDD should be avoided, and the risk should not be overlooked even in patients at a dose as low as a quarter of 1 DDD,” Dr Wang added.

“Fourth, this novel finding of respiratory adverse events from antipsychotics should be considered when weighing benefits against risks of using antipsychotics in COPD patients, but patients are not suggested to discontinue antipsychotics without consulting their physicians. In addition, we advise COPD patients on antipsychotics not to neglect symptoms of breathing difficulty or respiratory abnormalities and should seek medical help as soon as possible,” he added.

Commenting on the findings for Medscape Medical News, Dr Janna Gordon-Elliott, psychiatrist at Weill Cornell Medicine and New York–Presbyterian Hospital in New York City, said the article is “notable because it highlights a risk with antipsychotics that I don’t think is high up on our radar. In reviewing the literature after reviewing this paper, I am struck by how little this risk is talked about,” said Dr Gordon-Elliott, who was not involved in the study.

“This correlational study doesn’t necessarily put the nail in the coffin and can’t prove causation, although they did a really nice job of controlling for a lot of factors, and with this large population sample, they do show that this is more than just a few case reports,” she added.

“What the paper doesn’t tell us is why these COPD patients were on antipsychotics, and that’s probably just beyond the scope of the paper. But antipsychotics are being used off label in a lot of patients, and this paper should really make us think twice about that in patients with lung disease,” Dr Gordon-Elliott said.

The study had no commercial funding. The authors have disclosed no relevant financial relationships.

JAMA Psychiatry. Published online January 4, 2017. Abstract

http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2595040

Posted in Recent Cases Blog and tagged , , , , , .

Ann Blake Tracy, Executive Director,
International Coalition for Drug Awareness
(DrugAwareness.Org & SSRIstories.Net)
Author: ”Prozac: Panacea or Pandora? – Our Serotonin Nightmare – The Complete Truth of the Full Impact of Antidepressants Upon Us & Our World” & Withdrawal CD “Help! I Can’t Get Off My Antidepressant!”

She has specialized since 1990 in adverse reactions to serotonergic medications (such as Prozac, Sarafem, Zoloft, Paxil, Luvox, Celexa, Lexapro, Effexor, Serzone, Remeron, Anafranil, Fen-Phen, Redux and Meridia as well as the new atypical antipsychotics Zyprexa, Geodon, Seroquel and Abilify), as well as pain killers, and has testified before the FDA and congressional subcommittee members on antidepressants.

WITHDRAWAL WARNING: In sharing this information about adverse reactions to antidepressants I always recommend that you also give reference to my CD on safe withdrawal, Help! I Can’t Get Off My Antidepressant!, so that we do not have more people dropping off these drugs too quickly – a move which I have warned from the beginning can be even more dangerous than staying on the drugs!

WITHDRAWAL HELP: You can find the hour and a half long CD on safe and effective withdrawal helps here: store.drugawareness.org And if you need additional consultations with Ann Blake-Tracy, you can book one at www.drugawareness.org or sign up for one of the memberships for the International Coalition for Drug Awareness which includes free consultations as one of the benefits of that particular membership plan. You can even get a whole month of access to the withdrawal CD with tips on rebuilding after the meds, all six of my DVDs, hundreds of radio interviews, lectures, TV interviews I have done over the years PLUS my book on antidepressants with more information than you will find anywhere else for only $30 membership for a month (that is only $5 more than the book alone would cost) at www.drugawareness.org. (Definitely the best option to save outrageous postage charges for those out of the country!)