Antipsychotics up risk of acute respiratory failure in adults

Use of antipsychotics results in an elevated risk of acute respiratory failure (ARF) in adult patients, results of a recent study have shown. This risk is dose-dependent and significantly greater with current use of antipsychotics agents at doses of 1 defined daily dose and above.

“Physicians should be vigilant about any respiratory symptoms in patients currently receiving antipsychotics at such dose,” the authors cautioned.

Only one population-based study has examined the safety issue of antipsychotics in chronic obstructive pulmonary disease patients despite the drugs being prescribed off-label in adults frequently. To determine whether antipsychotic use carried an increased ARF risk among adult patients, this nested case–control study was conducted.

A total of 716,493 adults aged ≥20 years were identified from the Taiwan nationwide healthcare claims records between January 2000 and December 2013. Of these, 7,084 adults with ARF and 12,785 disease risk score-matched randomly selected controls were analysed. Odds ratios of ARF with antipsychotic drugs were estimated through multivariable logistic regression models.

Compared with nonuse, current use was associated with a 2.33-fold (95 percent confidence interval [CI], 2.06–2.64) increased risk of ARF, while recent and past use correlated with a 1.79-fold (95 percent CI, 1.43–2.25) and 1.41-fold (95 percent CI, 1.20–1.66) risk increase, respectively. On the other hand, antipsychotics discontinued >90 days posed no risk.

There was a dose-dependent association with current therapy of antipsychotics (test for trend, p<0.001), wherein antipsychotic use at >1 defined daily dose generated the highest risk of 6.53-fold (95 percent CI, 3.33–12.79). The findings were robust to using carbamazepine as an active comparator, according to the authors.