Prescribing Sedatives to People with Alzheimer’s disease

Benzodiazepines increased risk of pneumonia in people with Alzheimer’s disease.

Alzheimer’s disease, like other forms of dementia, may cause agitation and restlessness in patients. While medications may help, there may also be risks.

A Finnish study found that the use of a class of medications called benzodiazepines increased the risk of pneumonia in people with Alzheimer’s disease.

Alzheimer’s disease is a form of dementia that appears in older patients and usually begins with gradual loss of memory. The disease causes changes to the structure of the brain.

People with Alzheimer’s may be more susceptible to infections such as pneumonia than those of a similar age who do not have dementia. Approximately 60 to 70 percent of dementia is caused by Alzheimer’s disease.

Heidi Taipale, PhD Pharm, led the study of more than 49,000 patients. Dr. Taipale is a post-doctoral researcher at the Kuopio Research Centre of Geriatric Care, University of Eastern Finland in Kuopio, Finland.

Two classes of sedatives are commonly used in people with dementia: benzodiazepines and non-benzodiazepines (known as Z-drugs).

Dr. Taipale and colleagues examined data on Finnish people with Alzheimer’s disease living in the community between 2005 and 2011. Most of the patients were women, with a mean age of 80. 5232 patients were taking benzodiazepines and 3269 were taking Z-drugs. The remaining patients were not taking sedatives.

People taking benzodiazepines had a 30 percent higher risk of developing pneumonia than either of the other groups. The risk was highest in the first 30 days after the medication was started

Benzodiazepines are known to increase the risk of pneumonia in all patients who routinely take the medication, possibly by increasing the chance of food aspiration into the lungs.

The link between Z-drugs and pneumonia was not statistically significant, but the researchers did not conclude Z-drugs were safer as the designed was not directly comparing the two medications.

Dr. Paula Rochon of Women’s College Hospital and the University of Toronto and her coauthors, writes in a related commentary that this study “is a good reminder to clinicians to ‘first do no harm’ when prescribing these drugs for frail older women and men with dementia. Nonpharmacologic approaches should be the starting point when managing neuropsychiatric symptoms in this patient population, which should help to limit inappropriate use of these drugs.”

The study was published in the April issue of the Canadian Medical Journal.

No outside funding was provided for the study.

Co-authors Heidi Taipale, Antti Tanskanen and Jari Tiihonen reported potential conflicts of interest in that they have received funding from pharmaceutical manufacturers such as Eli Lilly, AstraZeneca, F. Hoffman-La Roche, Bristol-Myers Squibb and GlaxoSmithKline, which manufacture benzodiazepines or Z-drugs.

Canadian Medical Association Journal, “Common sedatives linked to increased risk of pneumonia in people with Alzheimer’s disease”
Canadian Medical Association Journal, “Risk of pneumonia associated with incident benzodiazepine use among community-dwelling adults with Alzheimer disease”
Written by: Beth Greenwood, RN | Medically reviewed by: Dr. Robert Carlson, M.D.