Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Benzodiazepine Use & Risk of Pneumonia

CHEST; 2018 Jan; Chen, Winkelman, et al

There is a dose-response relationship between current benzodiazepine receptor agonist (BZRA) use and the risk of hospitalization for pneumonia, a recent study suggests. The population-based nested case-control study conducted between 2002 and 2012 included new BZRA users who did not have any BZRA prescriptions in the preceding 2 years and identified 12,002 individuals hospitalized for pneumonia and 12,002 disease risk score-matched control subjects. Researchers found:

  • Current BZRA exposure was associated with hospitalization for pneumonia (adjusted OR [aOR], 1.86).
  • Benzodiazepine hypnotic agents (aOR, 2.42) had a higher risk of pneumonia than did benzodiazepine anxiolytic agents (aOR, 1.53) or nonbenzodiazepine hypnotic agents (aOR, 1.60).
  • Midazolam had a higher risk (aOR, 5.77) of hospitalizations for pneumonia than other individual BZRAs.


Chen T, Winkelman JW, Mao W, et al. The use of benzodiazepine receptor agonists and the risk of hospitalization for pneumonia. A nationwide population-based nested case-control study. CHEST. 2017;153:161-171. doi:10.1016/j.chest.2017.07.030.


Benzodiazepine use, particularly when used as a sleep aid, has many adverse effects and this study adds another potential adverse effect to the list. Psychotropic and hypnotic drugs can impair cognitive and psychomotor abilities. In fact, a 2013 study suggested an increase in motor vehicle accidents in individuals who were taking benzodiazepines or other sleep enhancing medications such as zolpidem.1 Remember, due to excess daytime sedation, the FDA in 2013 lowered the recommended dose of zolpidem due to excessive daytime sleepiness.2 The current study gives another reason to think twice before prescribing benzodiazepines to aid with sleeping. — Neil Skolnik, MD

  1. Chang CM, Wu EC, Chen CY, et al. Br J Clin Pharmacol. 2013;75(4):1125-33. doi:10.1111/j.1365-2125.2012.04410.x.
  2. US Food and Drug Administration. FDA Safety Announcement. Risk of next-morning impairment after use of insomnia drugs; FDA requires lower recommended doses for certain drugs containing zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist). January 10, 2013. Accessed January 10, 2018.