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Reducing prescribing cascades.

Aaron M Tejani1, Thomas L Perry

  • 1Department of Anaesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver. aaron.tejani@ubc.ca.

African Journal of Primary Health Care & Family Medicine
|April 2, 2025
PubMed
Summary
This summary is machine-generated.

Prescribing cascades, where side effects lead to new prescriptions, worsen polypharmacy. Recognizing and preventing these medication cascades improves patient safety and outcomes.

Keywords:
adverse drug eventsdeprescribingpolypharmacyprescribing cascade

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Area of Science:

  • Geriatric Medicine
  • Clinical Pharmacology
  • Patient Safety

Background:

  • Polypharmacy, the use of multiple medications, is increasing in older adults.
  • Drug-induced adverse events are often misdiagnosed as new conditions, leading to further prescriptions.

Purpose of the Study:

  • To define prescribing cascades and their contribution to polypharmacy.
  • To identify common prescribing cascades and discuss prevention strategies.

Main Methods:

  • Literature review of prescribing cascades.
  • Analysis of drug-induced adverse events leading to further medication initiation.

Main Results:

  • Anticholinergic use can cause cognitive impairment, dyspepsia, or constipation, leading to prescriptions for dementia medications, proton pump inhibitors, or laxatives.
  • Calcium channel blockers and gabapentinoids may cause edema, prompting unnecessary diuretic prescriptions.

Conclusions:

  • Prescribing cascades are a significant driver of polypharmacy and associated risks.
  • Preventive strategies include vigilant adverse effect monitoring, deprescribing, and enhanced clinician education on symptom interpretation.