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Antipsychotic Medications May Increase Risks for Respiratory Failure in Patients with COPD

Antipsychotic Medications May Increase Risks for Respiratory Failure in Patients with COPD

If you or a someone you know was being treated with antipsychotics, was diagnosed with chronic obstructive pulmonary disease (COPD), and suffered acute respiratory failure (ARF), you may be entitled to compensation for medical bills, lost wages, pain and suffering, and other damages.

Parker Waichman LLP continues to offer free legal consultations to individuals with questions about filing a lawsuit over antipsychotic adverse reactions associated with a COPD diagnosis. Our personal injury lawyers are offering a free consultation to anyone who sustained an injury associated with antipsychotics was diagnosed with the lung disease, and who suffered ARF. Parker Waichman urges you to contact one of our lawyers today to protect your legal rights.

What are Antipsychotics?

According to the National Institute of Mental Health (NIMH), antipsychotic drugs are principally used to manage psychosis, conditions that affect the mind and involve some loss of contact with reality, typically including delusions (false, fixed beliefs) or hallucinations (hearing or seeing things that are not there). Psychosis may be symptomatic of a physical condition, including drug abuse or mental disorders such as schizophrenia, bipolar disorder, or very severe depression. Very severe depression may also be known as psychotic depression.

In some cases, antipsychotic medications are used with other medications to treat delirium, dementia, and mental health conditions, including such Attention Deficit Hyperactivity Disorder (ADHD), severe depression, eating disorders, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), and generalized anxiety disorder. Antipsychotics do not cure the conditions for which they are prescribed, but are meant to help relieve symptoms and improve the patient's quality of life.

Older or first-generation antipsychotics are also known as conventional or typical antipsychotics and include, for example: Thorazine (chlorpromazine), Haldol (haloperid), and Prolixin (fluphenazine). Newer or second generation antipsychotics are also known as atypical antipscyhotics and include, for example: Risperdal (risperidone), Zyprexa (olanzapine), Seroquel (quetiapine), Geodon (ziprasidone), Abilify (aripiprazole), and Invega (paliperidone), Latuda (lurasidone).

Antipsychotics are also prescribed for the treatment of schizophrenia and the manic phase of bipolar disorder, according to the NIMH. Some have been used to treat bipolar depression or depression that has not responded to antidepressant drugs alone.

Research Ties Antipsychotic Use in COPD Patients with Respiratory Failure

Antipsychotic Drugs Increase Risks for Respiratory Failure

A recent study has found that antipsychotic drugs may advance risks for acute respiratory failure in patients diagnosed with COPD. The risk, according to researchers, is dose dependent. No safe dose was found and the Taiwanese researchers discovered that both typical and atypical antipsychotics were found to have similar risks, according to MedPage Today.

The population-based, case-crossover study found that more COPD patients had filled a prescription for antipsychotics in the two weeks before suffering acute respiratory failure when compared with a control period several months prior (11.7 percent versus 8.8 percent), Meng-Ting Wang, PhD, of the National Defense Medical Center in Taipei, and colleagues, reported online in JAMA Psychiatry, MedPage Today wrote. This finding revealed a significantly increased risk of respiratory failure during the first two weeks of antipsychotic use, independent of cardiogenic, traumatic, and septic factors. A dose dependent risk of acute respiratory failure was associated with antipsychotics that rose from a 1.52-fold risk for a low daily dose to a 3.74-fold risk for a high daily dose.

"The results of this study indicated a life-threatening adverse respiratory effect of antipsychotic treatment, which has been described previously only in case reports," the researchers wrote.

Although antipsychotics have been linked to acute respiratory failure in case reports, population-level data are lacking, the researchers pointed out, MedPage Today wrote. The effect is of particular concern among COPD patients, especially those who are already prone to respiratory failure and who are commonly treated with antipsychotics.

For their study, the team looked at data from the Taiwan National Health Insurance Research Database for patients who were diagnosed with COPD and who were also newly diagnosed with acute respiratory failure either in the hospital or in an emergency care setting from January 1, 2000 to December 31, 2011. The protocol excluded patients who were diagnosed with prior acute respiratory failure; lung cancer; and cardiogenic, traumatic, or septic respiratory failure, according to MedPage Today. Cardiogenic respiratory failure occurs when the heart is suddenly unable to pump sufficient blood to meet the body's needs and is most often the results of a severe heart attack, the Mayo Clinic indicates. Septic respiratory failure involves severe sepsis (infection) that impacts the body's organs. Septic shock causes a significant drop in blood pressure that may cause respiratory or heart failure, stroke, other organ failure, and death, according to Healthline.

The study compared self-reported use of antipsychotics in the two weeks prior to the patients' respiratory failure with a control period of 75 to 88 days prior to the event in order to determine the main outcome. The research found that over "a mean of 3.5 years, a total of 5,032 of the 61,620 COPD patients were diagnosed with acute respiratory failure," according to MedPage Today. The research team also discovered that more patients filled at least one antipsychotic medication prescription during the study period than those during the control period. The increased risk persisted under a case-time-control analysis and nested case-control study and both typical and atypical antipsychotics revealed similar risks.

Specifically, according to JAMA, "in this population-based case-crossover study of 5032 patients with newly diagnosed ARF identified from 61,620 patients with" COPD, "after accounting for cardiogenic, traumatic, and septic ARF" and "proxies of the severity of" COPD, the use of antipsychotic drugs was associated with a 1.66-fold increased risk of ARF within 14 days" of the start of the medication. The "findings suggest an acute risk of ARF from antipsychotic use in patients with" COPD, "and future studies are required to confirm the observed association.

"Reducing the dose of antipsychotics seems to be a plausible strategy for lowering the risk of acute respiratory failure, but does not completely eradicate it, while high doses of antipsychotics should always be avoided whenever possible," Wang and colleagues wrote.

It remains unclear how antipsychotics may be associated with increased risks for respiratory failure, especially in patients diagnosed with COPD; however, researchers were able to propose some possible pathways. One option is that serotonin, dopamine, and histamine agonists activate the brain's respiratory pattern generator. This effect could become inhibited by antipsychotics. Another potential pathway is that "blocking dopamine D2 receptors could induce dystonia in the larynx." This could cause difficulty breathing. The third potential pathway involves a loss of serotonin 5HT2A activity in the medulla, which may cause the collapse of upper airway muscles, the researchers opined, according to MedPage Today.

Although the research was "limited by the potential for confounding by indication," given that psychosis may worsen patients' lung function, "that the ICD codes for acute respiratory failure were not ascertained, and critical confounders such as lung function test results and smoking status were unavailable, Wang and colleagues concluded that physicians should exert caution when prescribing antipsychotics to patients diagnosed with COPD and to avoid high doses, if possible. The researchers also concluded that, "Antipsychotic use is associated with an acute and dose-dependent increased risk of ARF in patients with COPD," according to JAMA.

Help for COPD Patients Who Suffered from Acute Respiratory Failure Following Use of Antipsychotics

Parker Waichman is offering free case evaluations to victims diagnosed with COPD who suffered from acute respiratory failure when taking antipsychotics. If you or someone you know is diagnosed with COPD and suffered from ARF when also taking antipsychotic medications, we urge you to contact us as soon as possible. Simply fill out our online form, or call 1-800-YOURLAWYER (1-800-968-7529) to discuss your case with us today.


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