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Original research
Prevalence of potentially serious alcohol–medication interactions in older adults in a community pharmacy setting: a cross-sectional study
  1. Alice E Holton1,
  2. Cora Keeney1,2,
  3. Benedict Ryan1,
  4. Gráinne Cousins1
  1. 1School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
  2. 2British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Gráinne Cousins; gcousins{at}


Objective Previous prevalence estimates of POtentially Serious Alcohol–Medication INteractions in Older adults (POSAMINO) are based on in-home inventories of medications; however, this method is associated with under-reporting of medications when compared with dispensing records. This study aims to estimate the prevalence of POSAMINO among community-dwelling older adults using drug dispensing data from the community pharmacy setting.

Design Cross-sectional study.

Setting Irish Community Pharmacy.

Participants 1599 consecutive older adults presenting with a prescription to 1 of 120 community pharmacies nationwide; community-dwelling, aged ≥65 years, able to speak and understand English, with no evidence of cognitive impairment. The mean age of sample was 75.5 years (SD 6.5); 55% (n=884) female.

Measures 38 POSAMINO criteria were identified using participants’ pharmacy dispensing records linked to self-reported alcohol consumption (beverage-specific quantity and frequency measures) over the last 12 months.

Results The overall prevalence of POSAMINO in the study population was 28%, with 10% at risk of at least one POSAMINO criteria and 18% at risk of two or more. Exposure to POSAMINO most commonly involved cardiovascular agents (19%) and central nervous system agents (15%). Exposure to a higher number of POSAMINO criteria was associated with younger age (adjusted incident rate ratio (AIRR): 0.97; 95% CI: 0.95 to 0.98), male sex (AIRR: 0.55; 95% CI: 0.45 to 0.67) and a higher number of comorbidities (AIRR: 1.05; 95% CI: 1.01 to 1.13).

Conclusion This study adds to the growing body of evidence, which suggests that older adults are vulnerable to potentially serious alcohol–medication interactions, particularly those involving cardiovascular and central nervous system agents, increasing their risk of orthostatic hypotension, gastrointestinal bleeds and increased sedation. Application of the POSAMINO criteria at the point of prescribing may facilitate the risk stratification of older adults and prioritise alcohol screening and brief alcohol interventions in those at greatest risk of harm.

  • epidemiology
  • geriatric medicine
  • old age psychiatry
  • public health
  • substance misuse

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • AEH and CK are joint first authors.

  • Contributors GC, AEH, CK and BR were involved in the conception and design of the study, interpreted the data, drafted the manuscript, revised the manuscript and gave final approval of the version to be published and agreed to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AEH, CK and GC undertook the acquisition and analysis of the work.

  • Funding This project was supported by the Royal College of Surgeons in Ireland.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the Royal College of Surgeons in Ireland, with all participants providing written informed consent (REC1365).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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