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Semin Respir Crit Care Med 2024; 45(06): 694-700
DOI: 10.1055/s-0044-1791827
Review Article

Medications to Modify Aspiration Risk: Those That Add to Risk and Those That May Reduce Risk

João Gonçalves-Pereira 
1   Intensive Care Unit, Hospital de Vila Franca Xira, Vila Franca de Xira, Portugal
2   Clínica Universitária de Medicina Intensiva, Faculdade de Medicina Lisbon University, Lisboa, Portugal
3   Grupo Infeção e Desenvolvimento em Sépsis (GIS-ID), Porto, Portugal
,
Paulo Mergulhão
3   Grupo Infeção e Desenvolvimento em Sépsis (GIS-ID), Porto, Portugal
4   Intensive Care Department, Hospital Lusíadas, Porto, Portugal
,
Filipe Froes
3   Grupo Infeção e Desenvolvimento em Sépsis (GIS-ID), Porto, Portugal
5   Chest Department, Centro Hospitalar Universitário Lisboa Norte, Hospital Pulido Valente, Lisboa, Portugal
› Author Affiliations Funding None.
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Abstract

Aspiration pneumonia results from the abnormal entry of fluids into the respiratory tract. We present a review of drugs known to affect the risk of aspiration. Drugs that increase the risk of aspiration pneumonia can be broadly divided into those that affect protective reflexes (like cough and swallowing) due to direct or indirect mechanisms, and drugs that facilitate gastric dysbiosis or affect esophageal and intestinal motility. Chief among the first group are benzodiazepines and antipsychotics, while proton pump inhibitors are the most well-studied in the latter group. Pill esophagitis may also exacerbate swallowing dysfunction. On the other hand, some research has also focused on pharmaceutical modulation of the risk of aspiration pneumonia. Angiotensin-converting enzyme inhibitors have been demonstrated to be associated with a decrease in the hazard of aspiration pneumonia in high-risk patients of Chinese or Japanese origin. Drugs like amantadine, nicergoline, or folic acid have shown some promising results in stroke patients, although the available evidence is thus far not enough to allow for any meaningful conclusions. Importantly, antimicrobial prophylaxis has been proven to be ineffective. Focusing on modifiable risk factors for aspiration pneumonia is relevant since this may help to reduce the incidence of this often severe problem. Among these, several commonly used drug classes have been shown to increase the risk of aspiration pneumonia. These drugs should be withheld in the high-risk population whenever possible, alongside general measures, such as the semirecumbent position during sleep and feeding.

Keywords

pneumonia - aspiration - angiotensin-converting enzyme inhibitor - substance P - pill esophagitis - swallow reflex


Publication History

Article published online:
25 October 2024

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