Doctoral Program in Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan; Medical Corporation Toujinkai, Fujitate Hospital, Osaka, Japan.
Department of Rehabilitation for Orofacial Disorders, Osaka University Graduate School of Dentistry, Osaka, Japan.
Respir Investig. 2024 Nov;62(6):1044-1050. doi: 10.1016/j.resinv.2024.09.003. Epub 2024 Sep 10.
Japan's super-aged society presents significant challenges, particularly with regard to managing aspiration pneumonia among older adults. We aimed to investigate the link between anticholinergic drug use and the incidence of aspiration pneumonia, primarily utilizing data from the Japanese Adverse Drug Event Report (JADER) database.
The primarily analysis included JADER data from the first quarter of 2004 through the third quarter of 2023, focusing on 2367 cases of aspiration pneumonia in individuals aged ≥60 years. The study examined the association of aspiration pneumonia with 49 drugs listed in the Anticholinergic Risk Scale, using the Reporting Odds Ratio for signal detection. A scoping review incorporating findings from MEDLINE and the Cochrane Library was conducted to validate these associations.
The primary analysis identified an increased risk of aspiration pneumonia associated with specific drugs, including clozapine, haloperidol, risperidone, quetiapine, and olanzapine. A total of 20 drugs were significantly associated with an increased risk of aspiration pneumonia. Our results emphasize the importance of considering the dopamine-blocking effects of these drugs, particularly in at-risk populations, such as older adults, and those with conditions, such as schizophrenia or Parkinson's disease.
The study highlights the importance of careful monitoring of anticholinergic drugs with potent dopamine-blocking effects, such as clozapine, haloperidol, risperidone, quetiapine, and olanzapine, to reduce the risk of aspiration pneumonia. Future research should include observational and interventional studies to further investigate these findings.
As this study utilized pre-existing anonymized information, approval from an ethics committee was not required.
日本的超老龄化社会带来了重大挑战，尤其是在管理老年人吸入性肺炎方面。我们旨在利用日本不良药物事件报告（JADER）数据库中的数据，主要研究抗胆碱能药物使用与吸入性肺炎发病之间的关系。
主要分析包括 2004 年第一季度至 2023 年第三季度 JADER 数据库中 2367 例年龄≥60 岁的吸入性肺炎患者的数据。该研究使用报告比值比（ROR）检测信号，检查了 49 种抗胆碱能风险量表中列出的药物与吸入性肺炎的关联性。同时进行了范围综述，纳入 MEDLINE 和 Cochrane 图书馆的研究结果，以验证这些关联。
主要分析确定了某些药物与吸入性肺炎风险增加有关，包括氯氮平、氟哌啶醇、利培酮、喹硫平和奥氮平。共有 20 种药物与吸入性肺炎风险增加显著相关。我们的研究结果强调了考虑这些药物的多巴胺阻断作用的重要性，特别是在高危人群，如老年人，以及患有精神分裂症或帕金森病等疾病的人群中。
该研究强调了仔细监测具有较强多巴胺阻断作用的抗胆碱能药物（如氯氮平、氟哌啶醇、利培酮、喹硫平和奥氮平）的重要性，以降低吸入性肺炎的风险。未来的研究应包括观察性和干预性研究，以进一步调查这些发现。
由于本研究利用了预先存在的匿名信息，因此不需要伦理委员会的批准。
