Reducing prescribing cascades

Prescribing cascades contribute to the increasing prevalence of polypharmacy and its associated risks, where a drug-induced adverse event is misinterpreted as a new condition and treated with additional medications. Notable cascades include the use of anticholinergics leading to cognitive impairment, dyspepsia or constipation, which then prompt prescriptions for dementia medications, proton pump inhibitors or laxatives, respectively. Similarly, calcium channel blockers and gabapentinoids often induce oedema, resulting in unnecessary diuretic use. Strategies for prevention include careful review of adverse effects, deprescribing where appropriate and clinician education to improve symptom interpretation and prescribing practices. Recognising these cascades can mitigate unnecessary interventions and improve patient outcomes.