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Prescribing Cascades with Recommendations to Prevent or Reverse Them: A Systematic Review
Oriane Adrien1, Atiya K Mohammad1,2, Jacqueline G Hugtenburg3
1Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands.
Drugs & Aging
|October 20, 2023
Summary
This review identifies 115 prescribing cascades, offering prevention strategies for 52. Healthcare providers need more information on alternative treatments to manage these drug-induced events.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Drug Safety
Background:
- Prescribing cascades, where one drug's adverse event leads to another prescription, pose a risk in clinical practice.
- Healthcare providers need accessible information to recognize and prevent these cascades.
Approach:
- A systematic review following PRISMA guidelines was conducted.
- Literature searches across multiple databases (OVID MEDLINE, Embase, CINAHL, Cochrane, Web of Science, Scopus) identified relevant studies.
- 115 prescribing cascades were identified, with descriptive summaries for 52, focusing on dose-dependency and management recommendations.
Key Points:
- 115 prescribing cascades were identified, with confirmed adverse drug reactions and significant associations.
- Dose-dependency was confirmed for 12 prescribing cascades (e.g., antipsychotics and anti-parkinsonian drugs).
- Recommendations included dosage adjustments, medication discontinuation, and switching, with limited explicit alternatives provided.
Conclusions:
- An overview of 52 prescribing cascades with prevention/reversal recommendations was generated.
- Information on alternative medication options for managing prescribing cascades remains scarce.
- Further research is needed to provide comprehensive guidance on alternative treatments.
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