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08/09/2007 - Primary Care Physicians Do Not Educate Patient Regarding Potential Alcohol-Prescription Drug Interactions
A majority of adults drink alcohol at least occasionally. Additionally, many take prescription or over-the-counter medications. This can create a risk of drug interactions, some of which can be extremely dangerous, even fatal.
Several known alcohol-drug interactions exist. For example, when taken with alcohol, sedatives can produce respiratory depression, ataxia, falls, and injuries. The 50% monthly prevalence of alcohol use, as reported by the National Institute on Alcohol Abuse and Alcoholism and the 7.5% prevalence of alcohol disorders (Substance Abuse and Mental Health Services Administration), as well as the association between alcohol use and many pharmacologically treated disorders, suggest that substantial numbers of patients may be at risk for alcohol–drug interactions.
A recent study at the University of Wisconsin looked at health habits, including alcohol use, of some 900 primary care clinic patients that met Diagnostic and Statistical Manual of Mental Disorders, 4th edition, diagnostic criteria for alcohol abuse (continued drinking despite repeated adverse health or social consequences) or dependence (typical consequences of alcohol abuse, plus difficulty controlling drinking, preoccupation with drinking, and possibly a withdrawal syndrome upon sudden diminution of drinking).
Participants provided information on prescription drug use, including the product name, dose and number of doses per day. Each medication listed by the participants was checked for alcohol interactions in the DrugDex database of Micromedex, and then classified by mild, moderate, and severe interactions with alcohol.
After completing his or her medication list, each participant was asked a single yes-or-no question: whether they had been advised by a health care professional not to take any of the their medications with alcohol.
Of the 869 participants who provided legible information, 542 (62.4%) reported taking one or more prescription medications, and 348 (40.0%) reported taking at least one prescription in a risk category. Of these 348 participants, 315 indicated whether they had received advice about taking their medication(s) with alcohol. More than 47 percent of these participants said that they had not received advice.
More than 20 percent of participants reported taking at least one medication with a moderate or severe interaction with alcohol, suggesting that many primary care patients with alcohol-use disorders take prescription medications that could produce adverse effects when taken with alcohol.
The most commonly involved drug categories were psychotropics and analgesics. The most common agents were bupropion, various selective serotonin reuptake inhibitors, and acetaminophen, with the last agent usually combined with opioid analgesics.
Failing to provide advice on alcohol–drug interactions represents an important missed opportunity for primary practitioners. Providing such advice could prevent a serious adverse reaction that leads to hospitalization or death.
Additionally, professionals who prescribe and dispense such medications may be missing opportunities to provide effective education on alcohol–drug interactions and to deliver alcohol screening and intervention services that could ameliorate alcohol-use disorders.
Patients with alcohol-use disorders who are taking interacting medications need more counseling and education. Providing effective education on alcohol–drug interactions, as well as alcohol screening and intervention services, could help patients get treatment for alcohol-use disorders.