Benzodiazepines and Related Drugs Associated With Increased Pneumonia Risk

Pneumonia. Colored X-ray of the chest of a patient with bacterial pneumonia (pink, center right) in the lower lobe of the left lung (dark blue). The heart is at center right (orange). Bacterial pneumonia, which results in inflammation of the lung, is most commonly caused by the bacteria Streptococcus pneumoniae. The pathogen is inhaled into a lung segment, or lobe, where it causes the alveoli (air sacs) to become blocked with pus. It is most common after a cold, especially in those with a weakened immune system. Symptoms include fever and chills, a cough with rusty-colored or pus-like sputum and chest pain. Treatment is with antibiotics.
Current or recent exposure to benzodiazepines and related drugs may increase the risk for pneumonia.

Current or recent exposure to benzodiazepines and related drugs (BZRD) may increase the risk for pneumonia, according to results of a systematic review and meta-analysis published in the International Journal of Geriatric Psychiatry.

Investigators performed a systematic review and meta-analysis of observational studies that compared pneumonia development in patients receiving BZRD with pneumonia development in patients not receiving BZRD. Eligible studies were identified using PubMed and EMBASE. Data were extracted independently by 2 reviewers and discrepancies were resolved by a third author before the final analysis. Subgroup analyses were performed based on study design, age group, type of BZRD, BZRD half-life, exposure duration, and methodologic quality of study. Exposure windows were defined using 3 categories: (1) current use, or most recent prescription sold within 30 days; (2) recent use, or most recent prescription within 31 to 90 days of index date; and (3) past use, or most recent prescription beyond 90 days.

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Using keywords, a total of 3469 potentially eligible articles were identified; 58 were selected for full-text review. The final meta-analysis included 6 case-control studies and 4 cohort studies, which together comprised more than 120,000 pneumonia cases. A random effects meta-analysis of all 10 studies showed that BZRD use was significantly associated with increased pneumonia (odds ratio [OR], 1.25; 95% CI, 1.09-1.44; P <.001). Substantial heterogeneity was observed across studies, although sensitivity analyses indicated no substantial change in pooled risk estimates with the exclusion of any one study; the pooled ORs for pneumonia ranged from 1.16 to 1.26. An increased risk for pneumonia was associated with current (OR, 1.4; 95% CI, 1.22-1. 60) and recent (OR, 1.38; 95% CI, 1.06-1.80) BZRD use, although not with past BZRD use.

Current or recent exposure to BZRD was associated with pneumonia across several independent studies. These data suggest that clinicians should carefully consider the risk-benefit ratio of BZRD use, particularly for patients with other risk factors for pneumonia.


Sun GQ, Zhang L, Zhang LN, Wu Z, Hu DF. Benzodiazepines or related drugs and risk of pneumonia: a systematic review and meta‐analysis [published online January 8, 2019]. Int J Geriatr Psychiatry. doi: 10.1002/gps.5048