Another Holiday Season is upon us and for most, over indulgence goes hand in hand with the time of year. This includes food, sweets and alcohol and for seniors who are taking medications to treat a health condition, mixing drugs with drink can lead to serious or even deadly consequences.
Alcohol, by itself, is a problem for many seniors and the reasons are many.
Seniors need less alcohol than younger people to become intoxicated because of their slow metabolism and the fact that their bodies are not as efficient as younger people
Seniors stay drunk longer because their slow metabolism does not process alcohol as efficiently as younger people
Seniors with vision and hearing problem have these issues exacerbated by alcohol resulting in falls, accidents and other injuries
Because most seniors are using prescription medications, mixing them with alcohol could be dangerous and potentially fatal. Let’s look at some of the medications that can cause problems:
According to numerous health care providers, seniors who are using antidepressants are at a record high. Alcohol and antidepressants by themselves slow down the central nervous system and combining them increases the risk of impaired thinking skills and alertness. Alcohol may also worsen the symptoms of depression. For those taking a certain class of antidepressant called monoamine oxidase inhibitors (MAOI), alcohol should be avoided all together as its use can raise blood pressures to dangerous levels.
Blood Pressure and Heart Medications
For those with heart problems and taking beta-blockers, alcohol has been shown to decrease the effect of these medications. Those who are taking ACE inhibitors to control blood pressure or other heart related problems, alcohol can cause the blood pressure to drop too much.
Cholesterol Lowering Medications
Those taking statin drugs know that they have their liver function tested occasionally because these medications can have a damaging effect on the lover. Heavy alcohol use or binge drinking can exacerbate the damage done to the liver.
Those with diabetes should know alcohol can lower blood sugar up to 24 hours after the last drink. Low blood sugar can lead to a variety of medical emergencies and those who decide to drink need to make sure they have a snack to keep levels steady. A widely used medication for those with diabetes, metformin, when combined with alcohol, has been linked with a serious health issue called lactic acidosis, which causes nausea and muscle weakness. Other drugs used to treat diabetes, such as chlorpropamide, when mixed with alcohol, can cause flushing, dizziness, nausea and extremely low blood glucose levels.
Acid Reflux and Ulcer Medications
Those diagnosed with these conditions need to be aware that alcohol can relax the muscle between the stomach and esophagus and increase acid reflux even with the medication.
Drinking with over the counter pain relievers can be extremely harmful. Heavy or chronic drinking when taking acetaminophen can cause liver damage. Other over the counter pain controllers like aspirin and ibuprofen can cause stomach irritation leading to ulcers and even stomach bleeding. If using prescribed pain medications like Vicodin, OxyContin or Percocet, alcohol enhances the effects of these drugs causing increased sedation, fatigue and a drop-in blood pressure. A combination of the two can also suppress breathing and lead to death.
Combining sleeping pills such as Lunesta or Ambien with alcohol can increase sedation and depress parts of the brain which can result in severe drowsiness, sleepiness and dizziness leading to falls and accidents. Heavy drinking when taking sleeping pills can lead to very low blood pressure and breathing difficulties. It is recommended that if you do drink, wait at least 8 hours before taking any sleeping medications.
As a society, we have focused on the current ‘opioid epidemic’ and the over prescription of these pain killers. However, the use of benzodiazepines are at an all time high for seniors and these medications can be just as or even more dangerous than opiates and this problem is being ignored by the media. I did an earlier blog about the effects of these medications on seniors. I want to focus on these dangerous drugs once again.
Let me briefly describe what these drugs are and what they do.
Benzodiazepines are a medication commonly referred to as tranquilizers. Some of the most well known and most prescribed to seniors are Valium, Xanax and Klonopin. The are usually prescribed for anxiety, insomnia, seizure control and to relax prior to a surgery.
Although more than 2000 types of these medications are being produced, only fifteen are currently approved for use in the United States. They are usually classified by how long they have their desired effect upon the user. There are:
Ultra-short acting benzos – Midazolam (Versed) and triazolam (Halcion)
Short-acting benzos – Alprazolam (Xanax) and lorazepam (Ativan)
Long-acting benzos – Chlordiazepoxide (Librium) and diazepam (Valium)
Now let’s look at the risks of mixing benzodiazepines with alcohol:
Enhanced effects – when using both, they have what is known as a synergistic effect, meaning each enhances the effect of the other, leading to serious consequences.
Increased overdose risk – because alcohol and benzodiazepines are both CNS depressants, they can starve the brain of oxygen leading to brain damage and suppress breathing. A person’s body also metabolizes alcohol first when both drugs are present in the body leading to benzodiazepines remaining in the system longer. If a person takes a benzodiazepine on the regularly prescribed schedule yet high amounts of the previous dose remains unmetabolized, an overdose is possible.
Decreased cognition – mixing these two substances can reduce a person’s cognition leading to a reduction in normal inhibitions resulting in risky behaviors, poor decision-making skills, lowered reasoning abilities, inability to control emotions leading to hostile behaviors and even blackouts.
Lowered physical reactions – Reaction times and motor coordination are adversely affected leading to many potentially dangerous outcomes.
Increased side effect potential – anytime two CNS depressants are combined there can be serious side effects such as nausea, vomiting, lethargy and other allergic reactions.
Unpredictable side effects – in seniors, some of the side effects caused by mixing these substances have resulted in mistaken dementia diagnoses.
Development of acute conditions – mixing these substances can lead to serious and even deadly acute reactions such as heart attack, stroke, suicidal behaviors and seizures.
Risk of developing a mental disorder – mixing alcohol and benzodiazepines can cause depression, trauma and stress related disorders, psychotic disorders and other psychological conditions associated with individuals who are diagnosed with poly substance abuse
Increased risk of developing a Substance Use Disorder – using these drugs on a regular basis will lead to tolerance and addiction. Treating a polysubstance abuse disorder is much more difficult than treating a single substance use disorder.
Increased social problems – using these substances on a regular basis can lead to relationship issues, financial problems and interfere with goals. Those who have nest eggs put aside for retirement may end up spending all their money or losing property because of an addiction.
So if you are a senior or plan to spend time with seniors, take caution when drinking or serving alcohol and be aware of the dangers if prescription or some over-the-counter medications are being used.
Please download and print this handout on the dangers of mixing alcohol and medications for seniors.
Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.