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Table 1 Characteristics of included studies

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

Reference Setting Participants: N, sex, mean age (±sd), range Study design (survey mode) Measurement &Definition:
AI Medication(s) Alcohol Consumption Quantity/Frequency; thresholds applied
Adams 1995 [18] United States (US), retirement community residents N = 311
23% men
83 (± 6 years)
NR
Cross sectional (Mailed self-reported survey) Regular or occasional use of “high risk” meds in last 6 months: NSAIDS, aspirin, sedatives, narcotics, antidepressants, anti-hypertensives, antacids, H2 blockers, warfarin & meds for congestive heart failure, gout or diabetes. Reference source not reported Khavari questionnaire: quantity – frequency, last 6 months, None, 1–6 drinks/week or ≥7 drinks/week
1 drink = 12 oz. of beer, 5 oz. of wine, 3 oz. of fortified wine or 1.5 oz. of hard liquor.
Aira 2005 [19] Finland, community dwelling older adults N = 521
27% men
81 (± 4.4 years)
Range: 75–95.7 years
Cross sectional (Nurse interview; prescriptions & containers) Current use of medications having potential interactions with alcohol: Acetaminophen (Paracetamol), anticonvulsants, antidepressants, TCAs, antihistamines, benzodiazepines, H2 receptor antagonists, neuroleptics, nitrates, NSAIDs, opiates & warfarin. Reference source not reported Beverage specific quantity-frequency, last 12 months: None, 1–7 units/week, >7 units /week
1unit = 11-12 g of alcohol
Breslow 2015 [20] US, general population
≥ 20 years
≥65 years N = 7183
≥20 years N = 26,657
51% men
NR
Cross sectional (Interviews in-home, medication containers) Use of AI prescription medication, past month; identified using (i) Drugs.com, (ii) Caremark.com, (iii) Healthline.com, (iv) DailyMed databases & (v) references from 3 publications [12, 43, 44] including: cardiovascular agents, CNS agents, coagulation modifiers, GI, metabolic, psychotherapeutic & respiratory agents Quantity – frequency in last 12 months: None, for women of all ages & men >65 years: moderate consumption: >0–7 drinks/week & heavier drinkers (> 7 drinks/week). For men 20–64 years moderate: >0–14 drinks/week & heavier >14drinks/week
Cousins 2013 [21] Ireland, community dwelling older adults ≥60 years N = 3815
46.6% males
69.7 (±7.3 years)
Range: 60–99 years
Cross sectional (Nurse led interviews in-home; medications reviewed & self-completed questionnaire) Current or regular use of medications with potential to interact with alcohol identified using Stockley’s Drug Interactions, British National Formulary and Irish Medicines Formulary: cardiovascular agents, CNS agents, antihistamines, blood agents, antidiabetic agents, anti-infectives, GI drugs, immunomodulators & muscle relaxants Quantity-frequency, past 6 months: None,
Light/moderate (≤ 4 drinks/day or 10 drinks/ week) and heavy drinkers (>4 drinks/day or 10 drinks/ week)
1 drink = 10 g of alcohol
Del Rio 1996 [23] Spain, community dwelling adults
≥ 16 years
≥66 years N = 3003
≥ 16 years N = 21,084
48% men
NR
Cross sectional (survey with interview) Medication use, past 2 weeks. No reference source reported Beverage specific quantity-frequency, past 2 weeks
Del Rio 2002 [22] Spain, community dwelling adults
≥ 16 years
≥66 years = 1025
≥16 years N = 6396
48% men
NR
Cross sectional (survey with interview) Benzodiazepine use, past 2 weeks Beverage specific quantity-frequency past 2 weeks: Low (men: ≤ 21 units/week, women: ≤ 14 units/week), moderate (men: 22–50 units/week, women: 15–35 units/week) & high consumption (men: >50 units/week & women: >35 units/week)
1 unit = 10 g of alcohol
Du 2008 [14] Germany, community dwelling older adults N = 1605
45.2% men
NR
Range: 60–79 years
Cross sectional (survey & interview; prescriptions or original containers) Any psychotropic medication use in past 7 days: ATC nervous system drugs coded N00. (Excluded drugs coded N02B aspirin & paracetamol, except for N02BA71) Opiate codeines used as antitussives were merged with N02A & opiates for GI conditions (A07D) were not recorded Beverage specific quantity-frequency, past 12 months: Problem use (risky drinking): daily consumption ≥10 g for women & ≥ 20 g for men
Forster 1993 [24] US, community dwelling older adults N=667
39.9% men
74.1 (±6.6 years)
NR
Cross sectional (survey & interview; medication containers) Prescription or OTC medications currently or past month: AI drugs defined by study clinical team: OTC painkillers, anti-hypertensives, diuretics, OTC cold preparations, arthritis medications, heart medications, antibiotics, mind altering medications, chest pain medications, pain medications, diabetes medications, ulcer medications, sleeping pills, OTC nasal sprays, steroids, blood agents, insulin, seizure medications & OTC asthma medication Frequency: never, rarely, sometimes & regularly
Ilomaki 2008 [25] Finland, community dwelling older adults N=1,774
48.1% men
63 years (NR)
Range: 53-73 years
Cross sectional (mailed survey & interview; prescriptions brought if any problems) Regular use of psychotropic drugs at time of interview: antipsychotics, anxiolytics, hypnotics, sedatives, antidepressants & combinations Beverage specific quantity-frequency past 12 months: frequent ≥2 times/week, binge (men ≥5 units/occasion: women ≥4 units/occasion) & heavy drinking (men: >14 units/week: women >7 units/week
1 unit=12 g of alcohol
Ilomaki 2013 [26] Australia, community dwelling older men ≥70 years N=1,705
100% men
NR
NR
Cross sectional (Interview: medications brought) Antidepressants (including SSRIS, TCAs, MAOIs and others) & SADs (including benzodiazepines and benzodiazepine-like hypnotics) Beverage specific quantity-frequency past 12 months: daily (7days/week), binge (≥5 drinks at least once/month), heavy (>2 drinks/day) & problem drinkers (CAGE score ≥2). Nondrinkers: former or never drinkers
1 drink=10 g of alcohol
Immonen 2012 [27] Finland, community dwelling older adults ≥ 65 years N=1,395
35.5% men
78.7 years (NR)
NR
Cross sectional (mailed survey) Current prescribed medications: Swedish, Finnish Interaction X-referencing (SFINX) interaction database identified significant drug-alcohol interactions: metronidazole, tinidazole, disulfiram, griseofulvin, prazosin, metformin & tacrolimus. CNS agents, hypoglycaemics and warfarin Beverage specific quantity-frequency: At risk
(>7 drinks/ week, or ≥5 drinks on a typical drinking day or ≥3 drinks several times/week), moderate drinkers (at least 1 drink/month but < 7 drinks/week) & minimal/non-users (<1 drink/month)
1 drink = 12 g of alcohol
John 2007 [28] Germany, general population
≥ 20 years
NR
≥20 years N= 4290
49% men
NR
Range: 20-79 years
Cross sectional; (Interview; container or participant provided information on current medications) Use of sedative, hypnotics or anxiolytics (SHA) medicines including: barbiturates (& derivatives), benzodiazepines (& derivatives), carbamates, piperidinedione derivatives, hypnotics or anxiolytics & combinations of sedatives and hypnotics. SO group: included SHA and opioid, past 7 days Quantity of beverage specific alcohol consumed on last working day and last weekend: Risk drinking (men: >30 g/day & women >20g/day)
Lagnaoui 2001 [36] France, community dwelling older adults ≥65 years N=3767
41.7% men
NR
NR
Cross sectional; (Interview at home; adhoc questionnaire; visual inspection) Benzodiazepine use Quantity: Daily wine consumption divided into: I) none ii) moderate up to 0.25 l day -1 & iii) heavy > 0.25 l day -1 ( l day−1= litres consumed daily)
Onder 2002 [29] Italy, hospital admissions among older adults N = 22,778
45% men
70.3 (± 16 years)
NR
Cross sectional (questionnaire at admissions) Medications taken prior to admission, during hospital stay & prescribed at discharge: drugs classified according to risk of causing adverse drug reactions using Naranjo algorithm Quantity of daily consumption prior to hospital
admission: (daily wine units). Non-drinkers & moderate drinkers only, heavy alcohol users were excluded
Pringle 2005 [30] US, Pennsylvania Pharmaceutical Assistance Contract for the Elderly prescription drug users N = 83,321
19% men
78.8 (± 6.9 years)
Range: 65-106 years
Cross sectional (survey & prescription claims data) Filled prescriptions, past 45 days: drugs with potential for alcohol interactions (using First
Databank Inc. Drugs) with one of the following warnings considered AI:
1. May cause drowsiness; alcohol may intensify this effect
2. Do not drink alcohol when taking this medication
3. May cause drowsiness and dizziness; alcohol may intensify this effect
4. Limit alcohol while taking this medication; daily use of alcohol may increase risk of stomach bleeds
Current quantity-frequency:
Light: 1-7 drinks/month
Moderate: 8-30 drinks/month
Heavy: >30 drinks/month
Qato 2015 [31] US, community dwelling older adults N= 2975
48.6% men
NR
Range: 57-85 years
Cross sectional (In house interviews & observation medication bottles) Current or regular use (daily or weekly) with potential to interact with alcohol (Thomson Micromedex database). Drugs categorised according to severity of interaction:
1. Contraindicated: Drugs contraindicated for use with alcohol
2. Major: may be life-threatening or require medical intervention to prevent serious adverse events
3. Moderate: may result in exacerbation of individuals condition or require alternative therapy
4. Minor: limited clinical effects
Quantity-frequency last 3 months:
Non-regular drinkers: (none or <1 drink/week)
Light –regular: (≥ 1 drink/week & 1 drink/day)
Heavy-regular: (≥ 1 drink/week & 2-3 drinks/day)
Binge-regular: (≥ 1 drink/week & ≥4 drinks/day)
Sheahan 1995 [32] US, community dwelling & independent living congregate care facility older residents ≥ 55 years N=1028
26.9% men
73.5 (± 9.47 years)
NR
Cross sectional (In house interviews & medication container labels) Psychotropic medications in past year: sedatives/hypnotics, anxiolytics/tranquilizers, antidepressants & prescription pain medications Frequency, past year. Average number of times/week; month or year consumed alcohol.
Number of drinking days in past year calculated
Veldhuizen 2009 [34] Canada, community dwelling ≥ 15 years NR
≥15 years: N=36,984
49% men
N
Cross sectional study (Survey with interview, medication containers) Use of benzodiazepines (N03AE, N05BA and N05CD), non-benzodiazepine hypnotics (zopiclone, eszopiclone, zolpidem and zaleplon) during past 2 days among those who reported use in past 12 months Quantity-frequency on each of the previous 7 days among those drinking in past year: No drinking, moderate & heavy drinking (>14 drinks/week for men/ >9 drinks/week for women) or binge drinking (>4 drinks/day for women or 5 drinks/day for men)
1 drink= 1 bottle or can of beer/ glass of draft, 1 glass of wine/cooler or 1 ½ oz of liquor
Wong 2016 [35] America, community dwelling older adults N=2444
33% men
76.84 (±8.13 years)
Range: 60-103 years
Cross sectional (Face to face interviews) Prescriptions and OTC medications taken daily. Number of medications: low ≤ 1, moderate 2-4 & high ≥5 Quantity-frequency
Abstainers: no to alcohol & 0 drinkers/month, Light: yes to alcohol & <29 drinks/month, Moderate: yes to alcohol & 30 drinks/month, Heavy: yes to alcohol & >31 drinks/month
1 drink= 14g of alcohol