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Know before you mix: Counseling patients about alcohol–drug interactions

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Many senior patients may not realize the dangers of mixing alcohol with their medications. Alcohol interactions aren’t just limited to prescription medications. Harmful problems can occur with OTC products and even herbal remedies. In addition, alcohol may intensify a medication’s adverse effects or decrease the effectiveness of a medication. When counseling older patients about their medications, pharmacists should take the opportunity to discuss the problems associated with mixing alcohol and medications.

A hazardous combination

“The challenge is that the use of prescription and OTC medications is fairly prevalent, and it becomes even more prevalent in older patients with chronic conditions such as diabetes or high blood pressure,” said Ray Bullman, Executive Vice President of the National Council on Patient Information and Education (NCPIE). “In addition, many older patients are frequent drinkers, so combining medications with alcohol consumption is a serious problem.”

NCPIE is currently working with the Substance Abuse and Mental Health Services Administration to develop a social media campaign targeting adults aged 50 years and older and their caregivers to disseminate messaging on avoiding risks from combining alcohol and medication. The campaign will launch in the summer of 2015.

Older patients

According to results from the 2013 National Survey on Drug Use and Health, 5.6% of people aged 50–54 are considered heavy drinkers; 3.9% of those aged 55–59 are considered heavy drinkers; and 4.7% of people in the 60–64 age group are considered heavy drinkers. Research shows that aging slows the body’s ability to break down alcohol, so it remains in a person’s system for a longer period of time.

Alcohol and drug problems among older adults are frequently overlooked and misdiagnosed. According to the National Institute on Alcohol and Alcoholism, aging can lower the body’s tolerance for alcohol, and older patients often experience the effects of alcohol more quickly than when they were younger. When older adults drink, it puts them at a higher risk for falls and other injuries, in addition to interactions with medications.

Heavy drinking can also worsen certain health problems, including diabetes, high blood pressure, congestive heart failure, and osteoporosis. Mixing medications with alcohol may increase the risk of complications such as liver damage, heart problems, internal bleeding, impaired breathing, and depression.

According to the National Institutes of Health, when combined with alcohol, certain medications such as diazepam last longer in aging bodies, which creates a longer window of opportunity for interactions.

Counseling points

Data from the National Survey on Drug Use and Health suggest that 5.7 million adults aged 50 years or older will have drug or alcohol use disorders by 2020. With such a large number of the population at risk for medication−alcohol interactions, the pharmacist’s role in counseling patients is more important than ever.

Although many prescription medications are flagged with bright warning labels, cautionary language on OTC products may not be that easy for senior patients to see. The National Institute on Alcohol and Alcoholism reports that OTC medications that should not be mixed with alcohol include aspirin, acetaminophen, cold and allergy medicine, cough syrup, sleeping pills, pain medication, and anxiety or depression medications.

Pharmacists should be aware that women are more susceptible to alcohol-related damage to organs such as the liver than men are. The alcohol in a woman’s bloodstream typically reaches a higher level than a man’s even if both are drinking the same amount.

Pharmacists should counsel patients that many OTC painkillers and cough, cold, and allergy remedies contain more than one ingredient that can react with alcohol. Certain OTC medications such as cough syrup and laxatives may contain alcohol. Pharmacists should also make sure that senior patients understand that alcohol and medications can interact harmfully even if they are not taken at the same time.

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