The use of medication and alcohol among the Spanish population

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