B
J
Clin
Pha macol
1996;
41:
253-255
The use
o
medica ion and alcohol among
he Spanish popula ion
M. C. DEL
RIO,
C.
PRADA
&
F.
J.
ALVAREZ
Depa men o Pha macology and The apeu ics, Facul y o Medicine, Uni e si y o Valladolid,
47005
Valladolid, Spain.
The
1993
Spanish Na ional Heal h Su ey da a we e used o es ima e how
equen ly bo h medica ion and alcohol we e used among
21084
people o e
16
yea s o age.
A
o al o
47.1%
o he popula ion, especially women and an
inc easingly olde sec ion, had aken some kind o medica ion du ing he p e ious
o nigh .
A
o al o
9.8%
o he popula ion ook medica ion and alcohol oge he .
This was mo e equen ly obse ed among men han among women, and
especially
so
among he olde age g oups. These da a e eal ha concomi an
alcohol and medica ion use is equen among he Spanish popula ion, and
sugges
a
need o de o e much mo e a en ion o his po en ial p oblem.
Keywo ds
d ug-u iliza ion- ends alcohol d ug-in e ac ion
In oduc ion
Ad e se d ug in e ac ions a e an impo an clinical
p oblem and
i
is well-known ha se e al di e en
mechanisms a e in ol ed in hei pa hogenesis
[
1,2].
Concu en use o alcohol and medica ion may be o
signi icance, bu he e a e ew epidemiological s udies o
d ug-e hanol in e ac ions, and such s udies a e needed
in o de
o
e alua e whe he o no combined d ug-
e hanol in ake is haza dous.
Wi hin he Eu opean Union, Council Di ec i e
92/27/EEC
o
31
Ma ch
1992
on he labelling o medical
p oduc s o human use and on package lea le s
[3],
speci ies ha ‘ he package lea le shall be d awn up in
acco dance wi h he summa y o he p oduc cha ac e -
is ics; i shall include: o ms o in e ac ion wi h o he
medicinal p oduc s and o he o ms
o
in e ac ion ( o
example, alcohol, obacco, oods u s) which may a ec
he ac ion
o
he medicinal p oduc ’.
This pape documen s he equency o concu en
use o alcohol and medica ion among membe s o he
popula ion o e
16
yea s
o
age by means o da a om
he
1993
Spanish Na ional Heal h Su ey.
Me hods
The s udy was based on in o ma ion con ained in he
compu e da a base om he Na ional Heal h Su ey
ca ied ou by he Spanish Minis y o Heal h in
1993
[4].
A su ey o
26 334
people
(21 084
adul s and
5250
child en unde
16
yea s o age),
a
ep esen a i e sample
o non-ins i u ionalized Spania ds, was ca ied ou . We
only s udied he adul popula ion, since hose unde
16
yea s o age we e no asked abou alcohol consump ion.
A complex mul is age sample design was ea u ed. I
was designed as ollows: i s ly, by Spanish communi ies;
secondly, in se en s ages, acco ding o he numbe o
inhabi an s:
<2000
(n=
1849); 2001-10000 (n=3614);
10001-50000 (n=4855); 50001-100000
(n=
1782);
100 001-400
000
(n
=
4925); 400 001-1
000
000
(n
=
1354);
>
1
000000
(n
=
2689);
missing
(n
=
14);
hi dly, by ci ies
in each o he communi ies; and, inally, by sex quo as
(males
n
=
10
176;
emales
n
=
10
877;
missing
=
3 1)
and
age quo as
(16-25 n=4625; 26-35 n=3872; 36-45
n=
3250; 46-55 n=2979; 56-65 n=3025; 66-75 n=2133;
>
75
n
=
870;
missing
=
328).
When
a
pe son selec ed
was una ailable o unwilling o be in e iewed a
eplacemen was chosen. The numbe o such ins ances
is no known.
The ques ionnai e included, among o he s, i ems
ela ing o medica ion and alcohol consump ion. Those
su eyed we e asked i hey had aken any medicine in
he p e ious
2
weeks, and i
so,
wha kind o medicine
(using
17
di e en he apeu ic ca ego ies). Rega ding
alcohol, hey we e asked i in he p e ious
2
weeks hey
had aken any kind o alcoholic be e age, how o en
and how much. The ques ionnai es we e adminis e ed
by ained in e iewe s.
S a is ical analysis was by means o SAS so wa e
Ve sion
6.07
(SAS Ins i u e, SAS), which was used o
Co espondence: D F. Ja ie
Al a ez,
Depa men
o
Pha macology
and
The apeu ics, Facul y
o
Medicine, Uni e si y
o
Valladolid,
47005
Valladolid,
Spain
0
1996
Blackwell
Science
L d
253
254
M.
C.
Del
Rio
e al.
calcula e pe cen ages, odds a ios and 95% con idence
in e als.
A
P
alue
o
G0.05
was conside ed as
signi ican .
Resul s
A
o al o 47.1% (53.2% women, 40.5% men; odds a io
1.67, 95% CI 1.58-1.76) o he popula ion had aken
some kind o medica ion du ing he o nigh p io o
he su ey being ca ied ou (Figu e
1).
This inc eased
as he age o he popula ion inc eased. In addi ion,
24.9% o he popula ion consumed alcohol a leas once
pe day (39.9% men,
10.8%
women; odds a io
5.49,
95% CI
5.1
1-5.90). Alcohol consump ion was mo e
common among he middle-aged (Figu e
1
).
A
o al o 9.8% o he popula ion bo h ook
medica ion and consumed alcohol on
a
daily basis
(20.9% o hose aking medica ion), and his was mo e
equen among men (15.1%) han among women (4.9%;
odds a io 3.42, 95% CI 3.08-3.79). An upwa d end
was obse ed in join use as age inc eased in men (4.8%
among hose o 16-25 and 28.0% among hose o o e
75 yea s
o
age); bu his end was no obse ed o
women (Figu e
1
).
A
o al
o
29.6% o he popula ion ook only one
ype o medica ion, 10.1% wo ypes and
5.8%
h ee
ypes o mo e. The e we e ewe daily d inke s among
hose aking medica ion (20.9%; odds a io 0.66, 95%
CI
0.62-0.71) han among hose no aking medica ion
(28.2%). Inc easingly ewe indi iduals consumed
alcohol as he numbe
o
medicines inc eased (one ype
o medica ion 22.5%; wo 19.9%; h ee o mo e 14.6%).
Table
1
shows he pe cen age o he popula ion aking
each ype
o
medica ion and he combined use
o
medica ion and alcohol. The pe cen age
o
daily d inke s
anged om 11.1%
in
use s o an idep essan s and
23.2% in use s o espi a o y p oduc s.
Discussion
Use o medicines is known o be a common among
Wes e n popula ions IS], and he da a ob ained in ou
s udy con i m his: 47.1% o he popula ion, especially
emales and he elde ly, had aken medica ion du ing
he p e ious o nigh .
Ad e se d ug eac ions and in e ac ions a e common
clinical p oblems
[
1,2]. I is well-known, ha alcohol
in e e es wi h he me abolism o a la ge numbe
o
subs ances, mainly as
a
esul
o
i s enzyme induc ion
capaci y
[
1).
Howe e , he e is li le in o ma ion
a ailable abou he ex en o hese ypes o in e ac ions.
Acco ding o ou s udy, 9.8% o he popula ion, and
mo e equen ly males and olde ci izens, ake medi-
ca ion and d ink alcohol on a daily basis. Howe e , i
should be no ed ha alcohol consump ion is less
common among hose aking medica ion han hose
who do no , and he dec ease in he numbe o use s
is
accompanied by a co esponding all in he numbe
o
100%
To al
I
80%
60%
40%
20%
1
Ic
"
IU
16-25 26-35 36-45 46-55 56-65 66-75
80%
60%
40%
20%
0%
100%
80%
60%
40%
20%
0%
Male
16-25 26-35 36-45 46-55
Female
1
56-65
_n
I
56-75
1
16-25 26-35 36-45 46-55 56-65 66-75
Age (yea s)
Figu e
1
Use
o
medica ion
(O),
alcohol
(m)
and
>75
-1
>75
1.
>75
medica ion and alcohol
(+)
by
he Spanish popula ion
aged
o e
16
yea s.
medicines aken. Ou da a do no pe mi
us
o s udy
whe he o no in e ac ions ake place be ween d ugs
and alcohol bu hey do demons a e he equency
wi h
which medica ion and alcohol a e used join ly.
Fo all au ho ized medical p epa a ions which could
in e ac wi h alcohol, he e should be a wa ning
o
his
e ec in he Summa y
o
P oduc s Cha ac e is ics,
in
line wi h Eu opean Union egula ions [3]. In Spain
his wa ning can be ound in
437
cases (12.1
YO)
ou
o
a o al
o
3620 egis e ed d ugs.
No enough in o ma ion conce ning alcohol consump-
ion is gi en o pa ien s ecei ing pha macological
ea men
[
6,7]. In o de o a oid d ug-e hanol in e -
ac ions, physicians should de o e mo e a en ion
o
his
possibili y. Recen ly,
a
numbe o ad iso y p oposals
ha e been pu o wa d [8] aimed
a
a oiding ad e se
eac ions in olde pa ien s. This s udy shows ha middle
aged and olde pa ien s a e he mos equen use s o
0
1996
Blackwell
Science
L d
B i ish Jou nal
o
Clinic l
Pha mucology
41,
253
255
Sho epo
255
Table
1
Join use o medica ion and alcohol by pe sons
o e he age o 16 yea s
d ugs and alcohol, and unde lines he impo ance
o
hese p oposals.
Alcohol consump ion
Popula ion aking in use s
o
a ious
Class
o
medica ion he medica ion* classes
o
medica ion
W)
(%)
We a e g a e ul
o
he Minis e io de Sanidad
y
Consumo,
Subdi eccion Gene al de In o macion Sani a ia
y
Es adis icas
Sani a ias o p o iding
us
wi h he 1993 Encues a Nacional
de Salud compu e da a base.
An i heuma ics 4.8
Respi a o y p oduc s 14.9
Analgesics and 10.8
an ipy e ics
Vi amins 2.9
Hypo ensi es 7.8
Laxa i es 1.4
T anquillize s and 4.2
An idep essan s 1.5
An ibio ics 2.0
Con acep i es 1.2
An iobesi y 0.3
An ialle gic p oduc s 1.3
Choles e ol educe s 2.6
An idiabe ic he apy 2.3
Va ious 6.0
Ca diac he apy 3.3
Alimen a y ac 3.3
hypno ics
To al 47.1 Mean
17.3
23.2
21.4
17.7
16.9
15.8
19.7
22.9
16.6
11.1
17.1
15.8
16.8
18.7
17.3
14.9
20.0
20.9
*Please no e ha some pa ien s ake mo e han one class o
medica ion and hence he indi idual classes canno
be
added
up o each he o al.
Re e ences
1 S ockley IH.
D ug In e ac ions. A Sou ce Book
o
D ug
In e ac ions, Thei Mechanisms, Clinical Impo ance and
Managemen ,
Second Edi ion, Ox o d: Blackwell Scien i ic
Publica ions, 1991.
2 Ba y M. In e ac ions o d ugs wi h alcohol.
P ac i ione
3 Council Di ec i e 92/27/EEC o 31 Ma ch 1992
on
he
labelling o medicinal p oduc s o human use and on
package lea le s.
O sJ
EEC
1992;
no
L113.
4 Minis e io de Sanidad
y
Consumo.
Encues a Nacional de
Salud de Espaiia
1993.
Mad id: Minis e io de Sanidad
y
Consumo, 1995.
5
Leu kens
HG,
U quha
J.
Va iabili y in pa e ns
o
d ug
usage.
J
Pha m Pha macol
1994;
46
(Supp 1): 433-437.
6 Rowland N, Mayna d
A,
Be e idge
A,
Kennedy
P,
Win e sgill W, S one W. Doc o ha e no ime o alcohol
sc eening.
B Med
J
1987;
295:
95-96.
7 Bai s ow BM, Bu ke L, Beilin
J,
Deu sche C. Inadequa e
eco ding o alcohol-d inking, obacco-smoking and dis-
cha ge diagnosis in medical in-pa ien s: ailu e
o
ecognize
isks including d ug in e ac ions.
Med Educ
1993;
27:
8 S ein BE. A oiding d ug eac ions: Se en s eps o w i ing
1991;
235:
270-272.
518-523.
sa e p esc ip ions.
Ge ia ics
1994;
49
28-30.
(Recei ed 15 May 1995,
accep ed 14 No embe 1995)
0
1996
Blackwell Science
L d
B i ish Jou nal
o
Clinical Pha macology
41,
253-255