UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1687, USA.
Many older adults (ie, those aged >65 years) drink alcohol and use medications that may be harmful when consumed together.
This article reviews the literature on alcohol and medication interactions, with a focus on older adults.
Relevant articles were identified through a search of MEDLINE and International Pharmaceutical Abstracts (1966-August 2006) for English-language articles. The following medical subject headings and key words were used: alcohol medication interactions, diseases worsened by alcohol use, and alcohol metabolism, absorption, and distribution. Additional articles were identified by a manual search of the reference lists of the identified articles, review articles, textbooks, and personal reference sources.
Many older adults drink alcohol and take medications that may interact negatively with alcohol. Some of these interactions are due to age-related changes in the absorption, distribution, and metabolism of alcohol an medications. Others are due to disulfiram-like reactions observed with some medications, exacerbation of therapeutic effects and adverse effects of medications when combined with alcohol, and alcohol's interference with the effectiveness of some medications.
Older adults who drink alcohol and who take medications are at risk for a variety of adverse consequences depending on the amount of alcohol and the type of medications consumed. It is important for clinicians to know how much alcohol their older patients are drinking to be able to effectively assess their risks and to counsel them about the safe use of alcohol and medications. Similarly, it is important for older adults to understand the potential risks of their combined alcohol and medication use to avoid the myriad of problems possible with unsafe use of these substances..
"Alcohol tolerance also decreases with age (Kalant, 1998). Therefore, older adults may also be more prone to alcohol-related injury, and this risk may be further elevated by the fact that they are the largest consumers of medications that enhances the effect of alcohol (Moore et al., 2007; Nordfjaern et al., 2014). Due to the fact that consumption may be related to accidents, exaggerated alcohol responses due to organ changes and drug-alcohol interactions, targeted public health interventions among this sub-populations are prudent. "
[Show abstract][Hide abstract] ABSTRACT: Previous studies investigating human values and alcohol consumption have focused on adolescents, so the current study examined associations between human values and alcohol consumption in a cohort of Norwegians in the second half of life (40 years and above). Human values were studied within Schwartz’ theory [Schwartz, S. H. (1992). Universals in the Content and Structure of Values: Theory and Empirical Tests in 20 Countries. In M. Zanna (Ed.), Advances in Experimental Social Psychology (Vol. 25, pp. 1-65). New York: Academic Press.] A survey was conducted in 2002/2003 among Norwegians aged 40 to 79 years (n = 4 149). The respondents completed measures of human values, drinking frequency and typical drinking quantity. Females (9%) were more likely to report abstinence than males (3%). Males also reported a higher consumption level. Individuals with high education had lower levels of abstinence (4%) than those with basic education (7%), and high education was also related to more consumption. People aged 40-60 years were less likely to abstain from alcohol (3%) than individuals aged 61 years and above (10%). Unmarried individuals were more likely to report abstinence, but also reported somewhat higher consumption than married individuals. Multivariate analyses adjusting for demographics as well as somatic and mental health showed that Hedonistic values were related to lower probability of abstaining, while Conformity and Universalism values were associated with a higher probability of abstaining. Achivement and Hedonism values were associated with more alcohol consumption, whereas Universialism, Tradition and Conformity were related to lower alcohol consumption.
Substance Use & Misuse 12/2014; In press. DOI:10.3109/10826084.2014.998237 · 1.23 Impact Factor
"Physical activity, for its part, increases muscle strength and improves balance, thereby reducing the risk of both falls and fractures . The association between alcohol consumption and injuries among older people , for its part, may be both direct or due to potential interactions with some medications [21,22]. Studies reveal that poorer socioeconomic status is associated not only with poorer health but also with higher rates of injuries [13,15,23]. "
[Show abstract][Hide abstract] ABSTRACT: Background
The simultaneous use of several medications is an important risk factor for injurious falls in older people. The aim of this study is to investigate the effect of the number of medications dispensed to elderly persons on fall injuries and to assess whether this relationship is explained by individual demographics, health habits and health status.
A population-based, nested, case–control study on people 65 years and older (N = 20.906) was conducted using data from the Stockholm Public Health Cohort (SPHC) derived from self-administered surveys and linked at the individual level with various Swedish health registers. Fall injuries leading to hospitalization recorded in the Swedish National Patient Register (NPR) were considered as the outcome. The main exposure, obtained from the Swedish Prescribed Drug Register (SPDR), was the number of medications dispensed within 90 days prior to the injurious fall. The injury risk was estimated using adjusted odds ratios (ORs) from logistic regression. Results were adjusted by selected demographic, social circumstances, lifestyle and health status data extracted from the SPHC.
After adjusting for common risk factors within demographics, lifestyle, social circumstances and health status, using more than one medication increased the risk of fall injury but no clear dose–response relationship was observed, with point estimates ranging from 1.5-1.7 for the use of two, three, four or five or more medications as compared to using none. An increased risk remained, and was even elevated, after adjusting for the use of fall-risk-increasing drugs (FRIDs).
Using more than one medication affects the risk of injurious falls among older people. The effect of any given number of medications studied remains and is even strengthened after adjusting for individual demographics, health habits, health conditions and the use of FRIDs.
"For example, alcohol potentiates the sedative effects of benzodiazepines, antidepressants (e.g. tricyclics), anithisamines, muscle relaxants and opioids , giving rise to falls, car accidents and death [7,8]. Nonsteroidal anti-inflammatory drugs (NSAIDs), when combined with alcohol, can increase an older patients risk for gastrointestinal bleeding . "
[Show abstract][Hide abstract] ABSTRACT: Older adults are susceptible to adverse effects from the concomitant use of prescription medications and alcohol. This study estimates the prevalence of exposure to alcohol interactive (AI) medications and concomitant alcohol use by therapeutic class in a large, nationally representative sample of older adults.
Cross-sectional analysis of a population based sample of older Irish adults aged >=60 years using data from The Irish Longitudinal Study on Ageing (TILDA) (N = 3,815). AI medications were identified using Stockley's Drug Interactions, the British National Formulary and the Irish Medicines Formulary. An in-home inventory of medications was used to characterise AI drug exposure by therapeutic class. Self-reported alcohol use was classified as non-drinker, light/moderate and heavy drinking. Comorbidities known to be exacerbated by alcohol were also recorded (diabetes mellitus, hypertension, peptic ulcer disease, liver disease, depression, gout or breast cancer), as well as sociodemographic and health factors.
Seventy-two per cent of participants were exposed to AI medications, with greatest exposure to cardiovascular and CNS agents. Overall, 60% of participants exposed to AI medications reported concomitant alcohol use, compared with 69.5% of non-AI exposed people (p < 0.001). Almost 28% of those reporting anti-histamine use were identified as heavy drinkers. Similarly almost one in five, combined heavy drinking with anti-coagulants/anti-platelets and cardiovascular agents, with 16% combining heavy drinking with CNS agents. Multinomial logistic regression showed that being male, younger, urban dwelling, with higher levels of education and a history of smoking, were associated with an increased risk for concomitant exposure to alcohol consumption (both light/moderate and heavier) and AI medications. Current smokers and people with increasing co-morbidities were also at greatest risk for heavy drinking in combination with AI medications.
The concurrent use of alcohol with AI medications, or with conditions known to be exacerbated by alcohol, is common among older Irish adults. Prescribers should be aware of potential interactions, and screen patients for alcohol use and provide warnings to minimize patient risk.
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