Complications of Alcohol Use Combined with Drug Therapy in the Elderly

Abstract

Chronic ingestion of ethanol in alcoholic beverages can impair drug therapy, lead to sometimes hazardous interactions, or compromise adherence to a well-planned drug treatment program. Various drugs consistently interact with alcohol: CNS depressants, such as benzodiazepines, barbiturates, muscle relaxants, antihistamines, and psychotropic agents; analgesics, including aspirin and narcotics; anticoagulants and other cardiovascular drugs, namely digitalis glycosides, diuretics, antihypertensives, and antiarrhythmics; and antidiabetic agents. Abstinence from alcohol by elderly patients receiving these drugs is recommended.Since 95 million Americans consume alcoholic beverages on a regular basis and approximately 9 million more are alcohol-dependent,' it comes as no surprise that 61 per cent of persons over the age of 50 drink alcohol. In addition, the use of medications by the elderly is twice that of younger counterparts, and accounts for well over 25 per cent of all prescription and over-the-counter drug purchases in the United States.* This is substantial when one considers that those 65 years old or older represent only 11 per cent of the population of the United States.Elderly patients visiting private physicians regularly receive or renew at least one or two prescription drugs per visit. Patients in nursing homes are routinely maintained on four to six medications. Studies of prescribing patterns in hospitals and private offices indicate that cardiovascular agents, diuretics, aspirin and narcotic-containing analgesics, and psychotropics are the classes of drugs most frequently prescribed for elderly patientsS3s4 These agents also account for the greatest number of drug-related hospital admissions of the elderlya5 It is a sobering coincidence that clinically troublesome drug-alcohol interactions occur with the same classes of drugs.Alcohol use may lead to a variety of metabolic and organ system derangements. It can impair the effectiveness of routine drug therapy, or actively create new medical problems requiring additional therapy. Excessive alcohol use in association with medications in the elderly can severly compromise and complicate a well-planned therapeutic program. Even the moderate or intermittent use of alcohol can be harmful if the patient is taking certain of the potentially interacting drugs.

Self‐Management of Over‐the‐Counter Medications by Older Adults

“…The variety of OTC agents was determined by asking all subjects if they used aspirin, acetaminophen, laxatives, antacids, vitamins, cold medicines, ibuprofen, diarrhea medicines, allergy medicines, nausea medicines, sleeping medicines, nerve medicines, alcohol, nicotine, caffeine-containing beverages, or other unlisted medications obtained without a doctor's prescription. Caffeine, alcohol, and nicotine were included because they have pharmacologic effects, have documented potential for adverse interaction with prescription and nonprescription medications, and affect chronic diseases common among older adults, such as cardiovascular diseases and diabetes (Gerbino, 1982;Shimp et al, 1985).…”

Medication Use By Ambulatory Elderly

“…Noncompliance and polypharmacy frequently have been documented in the elderly, and adverse drug reactions are common 7–10 . Debilitating illnesses, perceptual deficiencies, and alcohol abuse are additional perturbing influences 11–14 . These various potentially deleterious factors, combined with burgeoning numbers of elderly, heighten the urgency of investigations in this arena.…”

Aging, Alcohol, and the Liver

“…Additive effects of acute alcohol consumption may occur, because acute alcohol consumption may increase the blood levels and CNS effects of tricyclic antidepressants 96 . All of the benzodiazepines, when taken with ethanol, have an increased central nervous system depressive effect 97 . In the case of the phenothiazines, increased ethanol blood levels have been reported after their concomitant administration, and there may be an increased risk of extrapyramidal reactions in the presence of ethanol 97 …”

“…Thus, the concurrent use of these drugs should be contraindicated. Antihistamines, likewise, frequently are sedating and in the presence of alcohol can have additive effects and produce hazardous conditions for the elderly 97 …”

“…Even though tolbutamide is cleared more rapidly in alcoholics, 106 alcohol decreases gluconeogenesis and may result in hypoglycemia for that reason. Oral hypoglycemics have also been associated with disulfiram(Antabuse)‐like reactions after alcohol intake 97 . The response to insulin in the elderly is apparently unchanged 107 …”