Drug safety in older patients with alcohol use disorder: a retrospective cohort study

Sebastian Schröder; Martin Schulze Westhoff; Tabea Pfister; Johanna Seifert; Stefan Bleich; Felix Koop; Phileas Johannes Proskynitopoulos; Alexander Glahn; Johannes Heck

doi:10.1177/20451253241232563

Drug safety in older patients with alcohol use disorder: a retrospective cohort study

Ther Adv Psychopharmacol. 2024 Feb 21:14:20451253241232563. doi: 10.1177/20451253241232563. eCollection 2024.

Authors

Sebastian Schröder¹, Martin Schulze Westhoff², Tabea Pfister², Johanna Seifert², Stefan Bleich², Felix Koop³, Phileas Johannes Proskynitopoulos², Alexander Glahn², Johannes Heck⁴

Affiliations

¹ Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
² Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
³ Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
⁴ Institute for Clinical Pharmacology, Hannover Medical School, Hannover, Germany.

Abstract

Background: Older patients with alcohol use disorder are at particular risk of developing adverse drug reactions due to multimorbidity, polypharmacy, and altered organ function.

Objectives: In this study, we investigated the frequency and characteristics of potentially serious alcohol-medication interactions, potentially inappropriate medications (PIMs) for older adults, and potential drug-drug interactions (pDDIs) in a population of older patients with alcohol use disorder over a 10-year period.

Design: Retrospective monocentric cohort study.

Methods: Prescribed medications were screened for potentially serious alcohol-medication interactions, PIMs, and pDDIs using the POSAMINO (POtentially Serious Alcohol-Medication INteractions in Older adults) criteria, the PRISCUS 2.0 list, the FORTA (Fit fOR The Aged) classification, and the drug interaction program AiDKlinik^®.

Results: We enrolled 114 patients aged ⩾65 years with alcohol use disorder, who were treated in an addiction unit of a university hospital in Germany. About 80.7% of the study population had at least one potentially serious alcohol-medication interaction. Potentially serious alcohol-medication interactions most commonly affected the cardiovascular (57.7%) and the central nervous system (32.3%). A total of 71.1% of the study population received at least one prescription of a FORTA C or D drug, compared with 42.1% who received at least one PIM prescription according to the PRISCUS 2.0 list. A total of 113 moderate and 72 severe pDDIs were identified in the study population.

Conclusion: Older patients with alcohol use disorders are frequently exposed to potentially serious alcohol-medication interactions, PIMs, and pDDIs. Improvements in the quality of prescribing should primarily target the use of cardiovascular and psychotropic drugs.

Keywords: alcohol use disorder; alcohol–medication interactions; drug safety; drug–drug interactions; older patients; potentially inappropriate medications.