Over half of all older Irish adults prescribed medications which have the potential to interact with alcohol, still regularly consume alcohol during the course of their prescription, a new study from RCSI (Royal College of Surgeons in Ireland)'s School of Pharmacy has found.

Alcohol can interact harmfully with certain prescription medications, which are known as alcohol interactive (AI medicines).The research, developed in conjunction with the Health Research Board (HRB) Centre for Primary Care Research and Trinity College Dublin (TCD), has recently been published in the journal BMC Geriatrics. This study is based on data from The Irish LongituDinal Study on Ageing (TILDA).

The study, led by Dr Gráinne Cousins, Lecturer in RCSI's School of Pharmacy, found that 72% of adults over the age of 60 residing in Ireland are prescribed AI medications. Of this figure, 60% of people reported consuming alcohol during the course of their prescriptions. Almost one in five older adults combined heavy drinking with cardiovascular agents and anti-diabetic agents, with 16% of the sample combining heavy drinking with central nervous system (CNS) agents.

The research also identified younger (aged between 60-64 years of age), urban dwelling men, with higher levels of education (with third-level qualification or higher), a history of smoking, and increasing co-morbidities were most at risk of exposure to heavy alcohol consumption and AI medications.

Speaking on these findings, Dr Cousins said, “Older adults are susceptible to adverse effects from the simultaneous use of prescription medications and alcohol, in part because of changes in absorption, distribution and metabolism of alcohol and other medication with age. The major adverse effects of mixing alcohol with such AI medicines can include the raising of blood alcohol levels, altering the metabolism of the drugs, liver toxicity, gastrointestinal inflammation and bleeding, sedation and interference with the overall effectiveness of the medication itself.”

Dr Cousins continued, “The use of psychotropic drugs (for example anti-depressants, anxiolytics, anti-psychotic medications) with heavy alcohol consumption is of particular concern to us as they may cause the most dangerous alcohol-related adverse drug reactions. For example, consumption of alcohol increases the sedative effects of benzodiazepines, anti-depressants, which can result in outcomes such as falls, motor vehicle accidents and even death.

“As the proportion and age of the older population continues to increase, the number of people using AI medications will also increase. If such alcohol consumption trends continue the number of older adults at risk of alcohol related drug events will increase in future years. Our findings emphasise the importance of patient education in understanding the potential risks associated with their combined alcohol and medication use. Prescribers and Pharmacists, should be aware of potential interactions, and screen their patients for alcohol use and provide warnings to minimise this risk to their patients.”

This study, which aimed to estimate the prevalence of exposure to AI medications and alcohol use in a nationally representative sample of older adults, also revealed a number of other key findings:

• More than one-in-10 people taking anti-epileptics, antipsychotics or hypnotics reported heavy drinking, with 18% of those taking antidepressants also reporting heavy drinking.
• The proportion of older adults at risk of alcohol related adverse drug events will increase in future years.

Of the 60% reporting concurrent alcohol and medication use:

• 28% who used anti-histamines were identified as heavy drinkers
• 20% combined heavy drinking with anti-coagulants, anti-platelets and cardiovascular agents