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Prescribing Cascades: How to Detect Them, Prevent Them, and Use Them Appropriately
Tobias Dreischulte1, Faiza Shahid, Christiane Muth
1Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich; Department of General Practice and Family Medicine, Medical Faculty OWL, University of Bielefeld; Philipp Klee-of Clinical Pharmacology, Helios Clinic Wuppertal; Clinical Pharmacology, Witten/Herdecke University, Witten/Herdecke; Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelbergg.
Prescribing cascades, treating adverse drug reactions (ADRs) with new medications, require careful assessment. While sometimes necessary, better tools are needed for physicians to identify and manage these cascades effectively.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Drug Safety
Background:
- A prescribing cascade involves treating an adverse drug reaction (ADR) with an additional medication.
- This review examines different types of prescribing cascades and strategies for their recognition and management in various healthcare settings.
Approach:
- A selective literature search was conducted to identify pertinent publications.
- The review analyzes intentional vs. unintentional and appropriate vs. inappropriate prescribing cascades.
Key Points:
- Essential questions for managing cascades include identifying the ADR cause, drug indication, and potential treatment alterations.
- Distinguishing between necessary and merely appropriate cascades is crucial for optimal patient care.
Conclusions:
- Prescribing cascades are not inherently negative and can be a necessary component of effective prescribing.
- A need exists for practical tools to aid physicians in reliably detecting, assessing, and utilizing prescribing cascades.
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