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Background: Poisoning is one of the serious underlying causes of loss of consciousness. Due to the relative lack of preserving factors of respiratory tract, risk of aspiration pneumonia would be increased. We evaluated factors associated with aspiration pneumonia in patients admitted with acute drug intoxication. Methods: A retrospective cohort randomized study conducted on 206 patients admitted at clinical toxicology department. Based on the diagnosis of aspiration pneumonia, patients were divided into two groups of with and without aspiration pneumonia. Binary logistic regression analysis was performed for aspiration pneumonia prediction factors. Findings: Age, gender, ingested toxin, vital sign, the level of consciousness on admission, gastric lavage, past history of smoking and pulmonary disease, seizure, vomiting, endotracheal intubation, and length of hospital stay were significantly different in patients with and without aspiration pneumonia (P < 0.05). Among variables, endotracheal intubation [odds ratio (OR) = 50.83], seizure (OR = 22.19), gender (men, OR = 3.49), pulse rate (OR = 1.03), age (OR = 1.03), and vomiting (OR = 0.20) were determinants factors in aspiration pneumonia. Conclusion: Seizure, age, male gender, pulse rate, vomiting, and endotracheal intubation should be considered as important factors in predicting aspiration pneumonia when managing poisoning cases.