Prevalence and risk of potentially adverse drug interactions in the treatment of acute alcohol poisoning

Andrade, Joyce Dalline Silva; Rocha, Chiara Erminia; Maciel, Maria Amélia Vieira; Santana, Danielle Cristine Almeida Silva de; Santana, Fernando José Malagueño de

doi:10.1590/S1984-82502016000100015

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Brazilian Journal of Pharmaceutical Sciences

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Articles • Braz. J. Pharm. Sci. 52 (01) • Mar 2016 • https://doi.org/10.1590/S1984-82502016000100015 copy

Prevalence and risk of potentially adverse drug interactions in the treatment of acute alcohol poisoning

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The aim of this paper is to determine the profile of acute alcohol poisoning and to estimate the risk of potentially adverse drug interactions (ADIs) in patients intoxicated by alcohol when attended in emergency care at hospital. A descriptive serial cross-sectional study was performed with 4,271 individuals intoxicated by alcohol, from January 2009 to July 2011. Possible correlations were measured by Pearson's chi-square test. The data show high consumption in the population, especially in males between 25 and 59 years. The main circumstances for poisoning were alcohol misuse (96.3%). After treatment complete recovery from the signs or symptoms of the poisoning was observed in 96.88% cases; and death in 0.70%. The demonstration of potential risk for ADIs in medical care included 300 medical records which contained a history of acute alcohol poisoning. Possible drug-drug interactions (44.2%) and drug-alcohol interactions (55.8%) were demonstrated in 60.60% of analyzed medical records. Among these cases, 3%, 92.4% and 4.6% were classified as mild, moderate and severe, respectively. The measurement of ADIs aims to prevent clinical complications in medical care for alcohol misuse disorders.

Uniterms:
Alcoholic intoxication; Emergency Medical Services; Risk Management; Medicines/adverse interactions/risk control; Medicines/alcohol interactions/risk control.

Variables	AF^a (n)	RF^b (%)
Gender
Men	3,793	88.81
Women	478	11.19
Total	4,271	00
Age group (yrs.)
01 ┤11	5	0.12
12 ┤17	89	2.08
18 ┤24	530	12.41
25 ┤34	1,038	24.31
35 ┤44	1,134	26.56
45 ┤59	1,116	26.12
60 +	216	5.05
U*	143	3.35
Total	4,271	100
Place of Origin
Capital city	2,708	63.41
Neighboring cities	1,563	36.59
Total	4,271	100
Geographical Area
Urban	4,090	95.78
Rural	173	4.06
U*	7	0.16
Total	4,271	100
Circumstance
Abuse (misuse)	4,113	96.30
Accidental	101	2.36
U*	57	1.34
Total	4,271	100
Medical care outcome
Cured	4,138	96.88
Death	30	0.70
Not specified	103	2.42
Total	4,271	100

Circumstance	*Abuse		**Accident		***U	Total
Age group (yrs.)	AF^a	RF^b (%)	AF^a	RF^b(%)
01 ┤11	5	0.12	0	0		5
12 ┤17	85	2	3	0.07	1	89
18 ┤24	510	12	17	0.40	3	530
25 ┤34	1,009	23.62	16	0.37	13	1,038
35 ┤44	1,102	25.80	20	0.46	12	1,134
45 ┤59	1,092	25.56%	16	0.40	8	1,116
60 +	212	4.90%	2	0.04%	2	216
***U	98	2.30%	27	0.60%	18	143
Total	4,113	96.30%	101	2.34%	57	4,271

Potential DDIs^a	DDIs and adverse events	G^b	AF^c	RF^d (%)
Metoclopramide/scopolamine	Scopolamine anticholinergic antiemetic drug. It is used to treat nausea, vomiting, and motion sickness for alcohol intoxication. In association, scopolamine reduces the effects of metoclopramide prokinetic in GIT^e.	*M	18	9.13
Metoclopramide/diazepam	Diazepam is a sedative benzodiazepine drug. It decreases the progression of AWS^f and the development of seizures. In association, metoclopramide-antiemetic drugs increase the depressive effects of diazepam on the CNS^g and/or the respiratory system.	*M	15	7.61
Diazepam/omeprazole	Omeprazole is a proton-pump inhibitor drug showing a gastro protective effect on certain stomach and esophagus damage after alcohol abuse. In association, omeprazole increases diazepam pharmacological effects and serum levels through hepatic metabolic enzyme inhibition.	*M	10	5.07
Phenytoin/ranitidine	Ranitidine is a histamine H₂-receptor antagonist inhibiting excessive stomach acid production after alcohol drinking. In association, ranitidine increases the blood levels of phenytoin anticonvulsant drugs, leading to nausea, CNS dysfunction, in particular confusion, nystagmus, and ataxia; in depressed conscious states, seizures and coma, the latter occurring in more severe cases.	*M	9	4.57
Metoclopramide/tramadol	Tramadol is an opioid painkiller. Seizures may increase after concomitant use of tramadol with metoclopramide, which reduces the seizure threshold. Furthermore, CNS- and/or respiratory-depressant effects of metoclopramide are enhanced after concomitant use of tramadol.	**S	4	2.03
Metoclopramide/promethazine	Haloperidol and promethazine are neuroleptic drugs used for sedation of alcohol-related disruptive emergency patients - showing agitated, threatening, or violent behavior. The concomitant use of metoclopramide and neuroleptic drugs increases the incidence and severity of extrapyramidal reactions due to antidopaminergic additive effects.	**S	3	1.53
Metoclopramide/haloperidol		**S	2	1.01
Other interactions			120	69.91
Total			197	100

Potential DAIs^a	DAIs mechanism and adverse events	G^b	AF^c	RF^d (%)
Alcohol/metoclopramide	Metoclopramide increases alcohol ^eCNS depression compromising judgment, thinking, and psychomotor skills.	*M	75	25.08
Alcohol/diazepam	Alcohol increases diazepam and scopolamine CNS depressant effects.	*M	55	18.39
Alcohol/scopolamine		*M	27	9.03
Alcohol/Ketoprofen	The Ketoprofen anti-inflammatory drug, associated with alcohol, leads to gastrointestinal blood loss by inhibition of prostaglandins, decreasing mucosa gastrointestinal integrity.	*M	25	8.36
Alcohol/promethazine	Promethazine is an antihistamine neuroleptic drug with strong sedative and weak antipsychotic effects. It also serves to reduce motion sickness and has an antiemetic effect, as well as anticholinergic properties. It is used in AWS^f treatment. In association with alcohol, promethazine increases CNS depression leading to psychomotor disturbances, accelerating dystonic reactions in alcohol-intoxicated patients.	*M	23	7.69
Alcohol/phenytoin	Alcohol increases the pharmacological effects and plasma levels of phenytoin by inhibiting the enzymatic metabolism of phenytoin.	*M	20	6.69
Alcohol/phenobarbital	Phenobarbital is used to treat moderate and severe AWS in patients resistant to phenobarbital. In terms of DAI, acute alcohol consumption increases phenobarbital plasma levels by inhibition of hepatic enzymes and leading to impaired coordination, sedation and death.	**S	4	1.34
Alcohol/morphine	Morphine is a powerful opioid painkiller drug used in management of severe pain in the Emergency Department. Co-administration of CNS depressant drugs significantly compromises the ability of judgment, thinking, and psychomotor skills. Furthermore, it leads to respiratory depression, sedation, hyper-tension and coma (in severe cases).	**S	2	0.67
Other interactions			68	22.74
Total			299	100

Universidade de São Paulo, Faculdade de Ciências Farmacêuticas Av. Prof. Lineu Prestes, n. 580, 05508-000 S. Paulo/SP Brasil, Tel.: (55 11) 3091-3824 - São Paulo - SP - Brazil
E-mail: bjps@usp.br

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[1] *Correspondence: F. J. M. de Santana. Departamento de Ciências Farmacêuticas. Universidade Federal de Pernambuco. Av. Professor Artur de Sá, 50740-521 - Recife, PE. E-mail: fmalagueno@hotmail.com