Castle I-Jen P, Dong Chuanhui, Haughwout Sarah P, White Aaron M
CSR, Incorporated, Arlington, Virginia.
Department of Neurology, University of Miami, Miami, Florida.
Alcohol Clin Exp Res. 2016 Sep;40(9):1913-25. doi: 10.1111/acer.13167. Epub 2016 Aug 4.
Alcohol consumption may interfere with absorption, distribution, metabolism, and excretion of medications and increase risk of adverse drug reactions (ADR). Studies report increasing prescription medication use over time, with many U.S. drinkers using alcohol-interactive medication. This study identified trends in incidence of U.S. emergency department (ED) visits for ADR with alcohol involvement (ADR-A), compared characteristics and disposition between ADR-A visits and ADR visits without alcohol involvement (ADR-NA), and examined frequency of implicated medications in such visits for 2005 to 2011.
ADR visits were identified through the Drug Abuse Warning Network, a national surveillance system monitoring drug-related ED visits. Analysis accounted for sampling design effects and sampling weights. Estimates are presented for totals (ages 12+), age group, and/or sex. Trends were assessed by joinpoint log-linear regression. Differences between ADR-A and ADR-NA visits were compared using two-tailed Rao-Scott chi-square tests.
From 2005 to 2011, incidence of ADR-A visits increased for males and females ages 21 to 34 and females ages 55+. An average of 25,303 ADR-A visits ages 12+ occurred annually. Compared with ADR-NA visits, ADR-A visits were more likely to involve males, patients ages 21 to 54, and 2+ implicated drugs. Alcohol involvement increased odds of more serious outcomes from ADR visits. Central nervous system (CNS) agents were the most common medications in ADR-A visits (59.1%), with nearly half being analgesics (mainly opioid). About 13.8% of ADR-A visits involved psychotherapeutic agents, including antidepressants. Besides CNS and psychotherapeutic agents, ADR-A visits involved a higher percentage of genitourinary-tract agents (mainly for impotence) than ADR-NA visits. Sex and age variations were observed with certain implicated medications.
ED visits for alcohol-drug interactions can be prevented by avoiding alcohol when taking alcohol-interactive medications. Our results underscore the need for healthcare professionals to routinely ask patients about alcohol consumption and warn of ADR risks before prescribing and dispensing alcohol-interactive medications.
饮酒可能会干扰药物的吸收、分布、代谢和排泄，并增加药物不良反应（ADR）的风险。研究报告称，随着时间的推移，处方药的使用量在增加，许多美国饮酒者使用与酒精相互作用的药物。本研究确定了美国急诊科（ED）因酒精相关药物不良反应（ADR-A）就诊的发生率趋势，比较了ADR-A就诊与无酒精相关的药物不良反应（ADR-NA）就诊的特征和处置情况，并调查了2005年至2011年此类就诊中涉及药物的频率。
通过药物滥用预警网络识别药物不良反应就诊情况，该网络是一个监测与药物相关的急诊科就诊情况的全国性监测系统。分析考虑了抽样设计效应和抽样权重。给出了总数（12岁及以上）、年龄组和/或性别的估计值。通过连接点对数线性回归评估趋势。使用双尾Rao-Scott卡方检验比较ADR-A和ADR-NA就诊之间的差异。
2005年至2011年，21至34岁的男性和女性以及55岁以上的女性因ADR-A就诊的发生率有所增加。12岁及以上人群每年平均有25303次因ADR-A就诊。与ADR-NA就诊相比，ADR-A就诊更有可能涉及男性、21至54岁的患者以及两种及以上相关药物。酒精的参与增加了药物不良反应就诊导致更严重后果的几率。中枢神经系统（CNS）药物是ADR-A就诊中最常见的药物（59.1%），其中近一半是镇痛药（主要是阿片类药物）。约13.8%的ADR-A就诊涉及心理治疗药物，包括抗抑郁药。除了中枢神经系统和心理治疗药物外，ADR-A就诊涉及的泌尿生殖道药物（主要用于治疗阳痿）的比例高于ADR-NA就诊。在某些相关药物中观察到了性别和年龄差异。
服用与酒精相互作用的药物时避免饮酒可预防因酒精与药物相互作用导致的急诊科就诊。我们的结果强调医疗保健专业人员有必要在开处方和分发与酒精相互作用的药物之前，常规询问患者饮酒情况并警告药物不良反应风险。
