De Las Cuevas Carlos, Sanz Emilio J, Villasante-Tezanos Alejandro G, de Leon Jose
Department of Internal Medicine, Dermatology and Psychiatry, School of Medicine, University of La Laguna, Canary Islands, Spain.
Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, San Cristóbal de La Laguna, Spain.
Expert Opin Drug Metab Toxicol. 2023 Feb;19(2):57-74. doi: 10.1080/17425255.2023.2192401. Epub 2023 Mar 29.
Antipsychotics (APs), during treatment or overdose, may be associated with respiratory aspiration.
A PubMed search on 30 September 2022, provided 3 cases of respiratory aspiration during clozapine therapy and 1 case during an AP overdose. VigiBase records of respiratory aspiration associated with APs from inception until 5 September 2021, were reviewed. VigiBase, the World Health Organization's global pharmacovigilance database, uses a statistical signal for associations called the information component (IC).
The ICs (and IC) were 2.1 (and 2.0) for APs, 3.2 (and 3.0) for clozapine, 2.6 (and 2.4) for quetiapine, and 2.5 (and 2.2) for olanzapine. Cases of respiratory aspiration associated with APs included: 137 overdose/suicide cases (64 fatal) and 609 cases during treatment (385 fatal) including 333 taking clozapine (238 fatal). In logistic regression models of fatal outcomes, the odds ratios, OR, and (95% confidence intervals, CI) of significant independent variables were: a) 2.3-2.6 for clozapine in 3 samples of AP treatment of varying size, b) 1.9 (CI 1.0 to 3.5) for geriatric age in 284 patients on clozapine treatment, and c) 1.8 (CI 1.1-3.2) for antidepressant co-medication in 276 patients on non-clozapine APs. Multiple AP pharmacological mechanisms may explain respiratory aspiration.
抗精神病药物（APs）在治疗期间或过量服用时，可能与呼吸误吸有关。
2022年9月30日进行的PubMed搜索，发现3例在氯氮平治疗期间发生呼吸误吸的病例以及1例AP过量服用期间发生呼吸误吸的病例。回顾了自开始至2021年9月5日VigiBase中与APs相关的呼吸误吸记录。VigiBase是世界卫生组织的全球药物警戒数据库，使用一种名为信息成分（IC）的关联统计信号。
APs的IC值（和IC）为2.1（和2.0），氯氮平为3.2（和3.0），喹硫平为2.6（和2.4），奥氮平为2.5（和2.2）。与APs相关的呼吸误吸病例包括：137例过量服用/自杀病例（64例死亡）和609例治疗期间病例（385例死亡），其中包括333例服用氯氮平的病例（238例死亡）。在致命结局的逻辑回归模型中，显著独立变量的比值比（OR）和（95%置信区间，CI）为：a）在3个不同规模的AP治疗样本中，氯氮平的OR为2.3 - 2.6；b）在284例接受氯氮平治疗的患者中，老年患者的OR为1.9（CI 1.0至3.5）；c）在276例接受非氯氮平APs治疗的患者中，联合使用抗抑郁药的OR为1.8（CI 1.1 - 3.2）。多种AP的药理机制可能解释呼吸误吸。
