Respiratory aspiration during treatment with benzodiazepines, antiepileptic and antidepressant drugs in the pharmacovigilance database from VigiBase

Carlos De Las Cuevas, Emilio J. Sanz, Jose de Leon

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Introduction: Three psychotropic drug classes, benzodiazepines, antiepileptic drugs (AEDs) and antidepressants (ADs), whether used in treatment or overdose, may be associated with respiratory aspiration. Polypharmacy was defined by counting suspected drugs from these classes or two others, antipsychotics and opioids. The confounding effects of polypharmacy were considered in this study. Areas covered: VigiBase records of respiratory aspiration associated with benzodiazepines, AEDs, and/or ADs from inception until 5 September 2021, were reviewed. VigiBase, the World Health Organization’s global pharmacovigilance database, uses a statistical signal for associations called the information component (IC). Expert Opinion: The ICs (and IC025) were benzodiazepines 2.8 (and 2.6), AEDs 1.6 (and 1.5), and ADs 1.4 (and 1.3). The cases of respiratory aspiration associated with at least one drug from these 3 classes included: 1) 553 cases absent any known overdose (2.8 ± 1.7 drugs) and 2) 347 overdose cases (2.9 ± 1.8 drugs). Little support for the association of respiratory aspiration and benzodiazepine, AED or AD monotherapy in therapeutic dosages was found. Studies of the association between benzodiazepine monotherapy and respiration aspiration are needed in geriatric patients. ADs added to other medications increased lethality in all cases of respiratory aspiration including those associated with overdose, polypharmacy and/or major medical problems.

Original languageEnglish
Pages (from-to)541-553
Number of pages13
JournalExpert Opinion on Drug Metabolism and Toxicology
Issue number9
StatePublished - 2022

Bibliographical note

Funding Information:
This paper was not funded. The authors are indebted to the national centers which make up the World Health Organization (WHO) Program for International Drug Monitoring and contribute reports to VigiBase. The information comes from a variety of sources, and the probability that the suspected adverse effect is drug-related is not the same in all cases. However, the opinions and conclusions of this study are not necessarily those of the various centers nor of the WHO. The requirements for accessing the VigiBase information are available on its webpage under the headings “Who may access VigiBase data?” and “How do I make a request for access to VigiBase data”?. The authors acknowledge Lorraine Maw, from the University of Kentucky Mental Health Research Center at Eastern State Hospital, who helped in editing the article.

Publisher Copyright:
© 2022 Informa UK Limited, trading as Taylor & Francis Group.


  • Airway obstruction
  • anticonvulsants/adverse effects
  • antidepressive agents/adverse effects
  • aspiration
  • benzodiazepines/adverse effects
  • deglutition disorders
  • drug overdose
  • intellectual disability
  • pneumonia
  • polypharmacy
  • respiratory aspiration

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology


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