Seniors Commonly Mix Alcohol With Meds

Deborah Brauser

January 23, 2015

Although many US adults of all ages put themselves at risk by mixing drugs and alcohol, this dangerous practice is especially prevalent in the elderly, new research shows.

Dr Rosalind Breslow

The large study conducted by investigators from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 42% of the 17,118 surveyed adults who reported recent consumption of alcohol also reported using alcohol-interactive (AI) prescription medications. However, 78% of those 65 years of age or older reported that they engaged in this practice.

"The combination of alcohol and prescription medications can have numerous side effects, especially in older adults," lead author Rosalind Breslow, PhD, epidemiologist in the Division of Epidemiology and Prevention Research at NIAAA, National Institutes of Health, told Medscape Medical News.

Coinvestigator Aaron White, PhD, a neuroscientist in the same division, noted that it is common for elderly patients to be taking multiple medications. Although physicians frequently discuss drug interactions with patients, he noted that it is also important that they talk to patients about drug interactions with alcohol.

Dr Aaron White

"What we'd like to see come out of this is better education regarding the potential for alcohol and medication interactions," said Dr White.

Dr Breslow added that although the study did not examine whether participants took both substances at exactly the same time, "our data show percentage of people who are at potential risk of an interaction."

The study was published online January 16 issue in Alcoholism: Clinical and Experimental Research.

Serious Medical Consequences

Although previous research has shown that commonly prescribed drugs can interact negatively with alcohol, causing falls, overdoses, and sometimes even death, "little is known" about the use of AI prescription medications among drinkers.

To examine the prevalence of this practice in the United States, researchers examined data from 1999 to 2010 from the National Health and Nutrition Examination Survey (NHANES) for 26,657 adults aged 20 years or older (51% men) who reported whether they had used prescription medications in the previous month and consumed alcohol in the previous year.

A total of 76.7% of the men and 65.7% of the women were considered "current drinkers." A total of 7183 of all participants were at least 65 years of age. In this older group, 3347 were current drinkers.

The NHANES also included a database of 1309 generic medications, classified by AI status.

"Medications are generally considered AI if their combination with alcohol alters 'the metabolism or activity of the medication and/or alcohol metabolism resulting in potentially serious medical consequences,' " report the investigators. After examining additional definitions, they included 591 medications as AI.

Results showed that unadjusted total prevalence of AI medication use in the full group was 42.8% (95% confidence interval [CI], 41.5% - 44.0%).

When examining just the current drinkers, the adjusted prevalence of AI medication use was 41.5% (95% CI, 40.3% - 42.7%).

Both measures in those who were at least 65 years of age were 78.6% (95% CI, 77.3% - 79.9%) and 77.8% (95% CI, 75.7% - 79.7%), respectively.

Simultaneous Exposure

For men, the unadjusted prevalence of any AI medication use was 37.7% vs 47.7% in women. For current drinkers only, the adjusted prevalence for men was 36.7% vs 46.3% for women.

Among all current drinkers, the most commonly used AI medication classes were cardiovascular agents (23.8%), followed by central nervous system (CNS) (14.6%), metabolic (14.2%), and psychotherapeutic agents (9.2%).

For the current drinkers aged 65 years or older, the most commonly used AI class was again cardiovascular agents (61.3%), followed by metabolic (36.5%), CNS (22.4%), and psychotherapeutic agents (9.6%).

Finally, 38.2% of all participants who consumed alcohol 5 to 7 days per week reported using any AI prescription medication.

"Our results suggest that there could be substantial simultaneous exposure to alcohol and AI prescription medication in [this] population," write the investigators.

Because of the adverse health risks that can come from these combinations, "future efforts are needed to collect data to determine actual...prevalence."

They add that both substances must be present in the body at the same time to correctly gauge adverse interactions. But from the questions asked, this study could only estimate potential prevalence.

"However, it is likely that those who drink regularly and take medication regularly are doing so in a similar time frame," the researchers note in a release.

Dr Breslow added that clinicians should ask specifically about alcohol consumption when talking with any of their patients, but especially those who are older, because certain medications react differently and/or metabolize more slowly in this population.

She and Dr White noted that the NIAAA offers "Harmful Interactions" pamphlets and the "Rethinking Drinking" website and self-guided assessment for patients. They also offer on their website a free clinician's guide on helping patients who drink too much.

"Alarming" Results

Reached for comment, Petros Levounis, MD, vice-chair of the American Psychiatric Association's Council on Addiction Psychiatry, told Medscape Medical News that "it is alarming" how many people were shown to be drinking while using AI medications.

Dr Petros Levounis

"What is particularly alarming is the significant percentage of that among the elderly. It's a concern in general, but it's even more of a dramatic concern for our elderly people," he said.

Dr Levounis, who was not involved with this research, is chair of the Department of Psychiatry at Rutgers New Jersey Medical School and chief of service at University Hospital in Newark.

He noted that when talking with patients about what they are consuming, "we're lucky to have them tell us about over-the-counter medications. But unless we specifically ask about alcohol, we never get that information."

Dr Levounis noted that he did have some problems with the study, particularly with the way AI medications were defined.

He pointed out the investigators first write that those causing "potentially serious medical consequences" would be included. However, medications were also included if there was "information on potential alcohol-medication interactions" on both Drugs.com and Caremark/Healthline.com databases; 567 drugs were included on this basis.

"We're going from a definition that is rather strict to a very wide definition of AI medications. That dilutes the results. In some ways, you're 'stuffing the ballot' or making it a little too alarming," he said.

"Also, there are some categories within that list that are far more alarming than others," said Dr Levounis, adding that the CNS agents of anxiolytics/sedatives/hypnotics and narcotics can be dangerous in combinations and with alcohol.

On the other hand, nonsteroidal anti-inflammatories have very little drug-drug interactions, "although there may be a potential for something there. But still, by no means should they be put in the same category," he said.

"If anything, we should teach our doctors to use more nonsteroidal anti-inflammatory medications so that they decrease the drug-drug interactions as compared with, for example, opioids. In other words, some of these are important as an alternative to the ones that are particularly dangerous."

Although he would have liked to have seen stricter definitions for AI medications, Dr Levounis said that the overall trend was still quite troubling and something that clinicians should note.

"I think the message is that the elderly are at particular risk and they need particular attention when it comes to alcohol-medication interactions," he concluded.

Dr Levounis reported no relevant financial relationships.

Alcohol Clin Exp Res. Published online January 16, 2014. Abstract

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