Concurrent use of alcohol interactive medications and alcohol in older adults: a systematic review of prevalence and associated adverse outcomes

Abstract

BackgroundOlder adults are susceptible to adverse effects from the concurrent use of medications and alcohol. The aim of this study was to systematically review the prevalence of concurrent use of alcohol and alcohol-interactive (AI) medicines in older adults and associated adverse outcomes.MethodsA systematic search was performed using MEDLINE (PubMed), Embase, Scopus and Web of Science (January 1990 to June 2016), and hand searching references of retrieved articles. Observational studies reporting on the concurrent use of alcohol and AI medicines in the same or overlapping recall periods in older adults were included. Two independent reviewers verified that studies met the inclusion criteria, critically appraised included studies and extracted relevant data. A narrative synthesis is provided.ResultsTwenty studies, all cross-sectional, were included. Nine studies classified a wide range of medicines as AI using different medication compendia, thus resulting in heterogeneity across studies. Three studies investigated any medication use and eight focused on psychotropic medications. Based on the quality assessment of included studies, the most reliable estimate of concurrent use in older adults ranges between 21 and 35%. The most reliable estimate of concurrent use of psychotropic medications and alcohol ranges between 7.4 and 7.75%. No study examined longitudinal associations with adverse outcomes. Three cross-sectional studies reported on falls with mixed findings, while one study reported on the association between moderate alcohol consumption and adverse drug reactions at hospital admission.ConclusionsWhile there appears to be a high propensity for alcohol-medication interactions in older adults, there is a lack of consensus regarding what constitutes an AI medication. An explicit list of AI medications needs to be derived and validated prospectively to quantify the magnitude of risk posed by the concurrent use of alcohol for adverse outcomes in older adults. This will allow for risk stratification of older adults at the point of prescribing, and prioritise alcohol screening and brief alcohol interventions in high-risk groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-017-0532-2) contains supplementary material, which is available to authorized users.

Alcohol complicates multimorbidity in older adults

“…6 Medications that interact with alcohol are widely prescribed to people who drink alcohol. 7 Alcohol can also have a direct and adverse effect on many conditions for which medications are prescribed, even when consumption is lower than that which is defined as low risk in drinking guidelines. 3 The damaging effects of alcohol consumption on the health of older people in the UK are evident in higher alcohol related hospital admissions and mortality among people aged over 65 than in younger people.…”

Disulfiram reaction

“…Lijekovi koji mogu biti potencijalni okidači neželjenih reakcija su najčešće: metronidazol, ketokonazol, tinidazol, trimetoprimsulfometoksazol, izosorbid dinitrat, nitroglicerin, pojedini preparati sulfonilureje. [12,13].…”

Consensus validation of the POSAMINO (POtentially Serious Alcohol–Medication INteractions in Older adults) criteria

“…While a number of studies have investigated the concurrent use of alcohol and AI medicines among older adults, 9 there is still a lack of agreement regarding the inclusion of AI medicines across studies. Several studies have reported on a broad range of medication classes, using different drug reference sources and software to identify medications as AI, thus leading to a lack of consistency in the inclusion of these medicines.…”

“…Several studies have reported on a broad range of medication classes, using different drug reference sources and software to identify medications as AI, thus leading to a lack of consistency in the inclusion of these medicines. 9 Other studies focused on psychotropic medications alone. 9 …”

“…Despite the findings of our previous systematic review, highlighting a high prevalence of concurrent use among older adults, no study to date has examined longitudinal associations of concurrent use with adverse outcomes. 9 An evidence-based list of potentially serious alcohol–medicine interactions for older adults has potential in a clinical setting, once validated, allowing for the identification of older adults whose alcohol consumption places them at increased risk and who would benefit from a preventative intervention. Therefore, the aim of this study is to derive the first set of explicit potentially serious alcohol–medication interactions in older adults.…”