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Consensus validation of the POSAMINO (POtentially Serious Alcohol–Medication INteractions in Older adults) criteria
  1. Alice E Holton1,
  2. Paul J Gallagher1,
  3. Cristín Ryan1,
  4. Tom Fahey2,
  5. Gráinne Cousins1
  1. 1School of Pharmacy, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
  2. 2Division of Population Health Science, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
  1. Correspondence to Alice E Holton; aliceholton{at}


Objectives Older adults are particularly vulnerable to adverse effects from concurrent alcohol and medication use. However, there is limited evidence regarding the prevalence of these adverse outcomes among older adults, and there is a lack of consensus regarding what constitutes an alcohol-interactive medicine. The objective of this study was to develop an explicit list of potentially serious alcohol–medication interactions for use in older adults.

Design Following a systematic review, review of drug compendia and clinical guidance documents, a two-round Delphi consensus method was conducted.

Setting Ireland and the United Kingdom (UK), primary care and hospital setting.

Participants The Project Steering Group developed a list of potentially serious alcohol–medication interactions. The Delphi panel consisted of 19 healthcare professionals (general practitioners, geriatricians, hospital and community pharmacists, clinical pharmacologists and pharmacists, and physicians specialising in substance misuse).

Results An inventory of 52 potentially serious alcohol–medication interactions was developed by the Project Steering Group. British National Formulary black dot warnings (n=8) were included in the final criteria as they represent ‘potentially serious’ interactions. The remaining 44 criteria underwent a two-round Delphi process. In the first round, 13 criteria were accepted into the POtentially Serious Alcohol–Medication INteractions in Older adults (POSAMINO) criteria. Consensus was not reached on the remaining 31 criteria; 9 were removed and 8 additional criteria were included following a review of panellist comments. The remaining 30 criteria went to round 2, with 17 criteria reaching consensus, providing a final list of 38 potentially serious alcohol–medication interactions: central nervous system (n=15), cardiovascular system (n=9), endocrine system (n=5), musculoskeletal system (n=3), infections (n=3), malignant disease and immunosuppression (n=2), and respiratory system (n=1).

Conclusions POSAMINO is the first set of explicit potentially serious alcohol–medication interactions for use in older adults. Following future validation studies, these criteria may allow for the risk stratification of older adults at the point of prescribing.

  • clinical pharmacology
  • adverse events
  • alcohol
  • geriatric medicine

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  • Contributors AEH, PJG, CR, TF and GC (the Project Steering Group) conceived and designed this study. AEH and GC conducted initial literature search. AEH communicated with Delphi participants. AEH analysed the data after each round. All Project Steering Group members were involved in interpretation of the data. AEH and GC drafted the manuscript. All coauthors revised the manuscript and gave the approval for publication.

  • Funding This study was funded by the Royal College of Surgeons in Ireland (RCSI), School of Pharmacy, Dublin 2, Ireland.

  • Competing interests None declared.

  • Ethics approval Ethical approval for this study was approved by the Royal College of Surgeons in Ireland (RCSI) ethics committee (REC 1097).

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

  • Data sharing statement Additional data are available by request from the corresponding author.