Benzodiazepines linked to increased risk of pneumonia in people with Alzheimer’s

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By Philip Tubby | Monday 10 April 2017

Canadian Medical Association Journal: Common sedatives linked to increased risk of pneumonia in people with Alzheimer’s disease

Researchers in Finland have found that sedative drugs called benzodiazepines are associated with an increased risk of pneumonia when used in people with Alzheimer’s disease. The study is published today (10 April) in the Canadian Medical Association Journal.

Benzodiazepines are sedatives, that can be used to reduce anxiety, relax muscles and help people to sleep. They are sometimes used to manage behavioural symptoms experienced by people with dementia, but have been linked to an increased risk of other conditions, such as pneumonia. A group of researchers in Finland set out to explore this link, in people with Alzheimer’s still living in the community.

The researchers used data from the MEDALZ cohort, which includes all adults living independently in the community in Finland who were diagnosed with Alzheimer’s disease between 2005 and 2011. The team were also able to gather prescribing information, from which they could establish the drugs that people had taken, including benzodiazepines. Using this information, the team compared the number of new cases of cases of pneumonia between people who took benzodiazepines and those who took Z-drugs, which have a different chemical structure but have similar effects to benzodiazepines. The benzodiazepines included in the study were diazepam, nitrazepam, chlordiazepoxide, clobazam, oxazepam, alprazolam, lorazepam and temazepam, and the Z-drugs were zopiclone and zolpidem.

The researchers then matched those people in their study group who took benzodiazepines or Z-drugs with those who did not take these medicines, taking into account the time since the participants were diagnosed with Alzheimer’s. They excluded people from the analysis if they had taken benzodiazepines or Z-drugs in the year before their Alzheimer’s diagnosis, allowing them to compare 5,232 people who took benzodiazepines with 5,232 people who did not, and 3,269 people who took Z-drugs with 3,269 people who did not. The team checked that the matching resulted in balanced groups over a number of factors, including gender, age, socioeconomic status, use of other drugs, and the presence of other diseases and conditions.

Analysing the groups, the researchers revealed that using benzodiazepines was associated with a 30% increased risk of developing pneumonia in people diagnosed with Alzheimer’s. The researchers also found that the risk was highest between 8-30 days of benzodiazepine use. They did not find a significant association between Z-drug use and the risk of developing pneumonia. The authors concluded by saying that the use of benzodiazepines should be carefully considered in people with Alzheimer’s, and the risk of pneumonia taken into account.

Dr Rosa Sancho, Head of Research at Alzheimer’s Research UK, said:

“With no drugs able to slow or halt the progression of Alzheimer’s disease, medicines are often used to help manage the symptoms that people may experience. Benzodiazepines can be given to people with Alzheimer’s to help calm very aggressive behaviour, but their use must be carefully weighed up against the risk of side effects for each individual. This new study suggests that the increased risk of pneumonia should be taken into account by doctors when considering the potential risks and benefits associated with prescribing benzodiazepines for people with Alzheimer’s. Anyone with concerns about the medications they are being prescribed for dementia should speak to their GP.”

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Philip Tubby