Alcohol-medication interactions among older people: a narrative review on age-specific evidence

Aims: Alcohol use is relatively common in older adults, representing a challenge for geriatricians. Older people are also prone to chronically taking multiple medications. Concerns are raised about potential alcohol-medication interactions (AMIs). This review aims to summarize current evidence on AMIs in older adults. Methods: We conducted a literature search using MEDLINE up to 18 June 2025. Of 481 identified studies, 37 were considered pertinent and discussed in this review. Results: Epidemiological data reveal that slightly over 25% (from ~20% to 80%) of older adults concurrently take alcohol and potentially interact with medications. Negative effects related to potential AMIs range from excessive sedation when old people take benzodiazepines, opioids, or antipsychotics, to hypoglycemia when they take sulfonylureas. Pharmacokinetic modifications can depend on physiological age-related changes in the human body. This evidence mostly derives from studies not focused on older adults. Conclusions: Despite their clinical importance, few studies focus on AMIs in older adults. The limited awareness among both healthcare providers and patients represents a significant public health issue. Routine alcohol use screening, universally shared lists of potential AMIs, and larger longitudinal studies are necessary to further explore the theme and mitigate risks.