Dihydropyridine Calcium Channel Blocker-induced Prescribing Cascades: Signal Detection using High-throughput Sequence...

Area of Science:

• Pharmacology
• Health Services Research
• Geriatric Medicine

Background:

• Dihydropyridine calcium channel blockers (DHP-CCBs) are common antihypertensives.
• Adverse effects of DHP-CCBs can lead to prescribing cascades (PCs), the initiation of new medications to manage side effects.
• Identifying DHP-CCB-induced PCs is crucial for optimizing patient care and medication safety.

Purpose of the Study:

• To identify potential prescribing cascades triggered by dihydropyridine calcium channel blockers (DHP-CCBs) using high-throughput sequence symmetry analysis (HTSSA).
• To evaluate the association between DHP-CCB initiation and subsequent prescriptions of other drug classes in a large Medicare cohort.

Main Methods:

• Utilized Medicare claims data from 2011-2020 for new users of DHP-CCBs aged 66 years and older.
• Applied high-throughput sequence symmetry analysis (HTSSA) to compare the initiation rates of 446 marker drug classes before and after DHP-CCB initiation.
• Adjusted sequence ratios (aSR) were calculated, and potential PCs were classified by clinical experts.

Main Results:

• Out of 388,862 DHP-CCB initiators, 82 marker drug classes showed significantly elevated aSRs, with 24 classified as potential PCs.
• Top potential PCs included systemic hemostatics, nasal preparations, and drugs for erectile dysfunction.
• Other significant signals included sulfonamides, electrolyte solutions, and osmotically acting laxatives, with varying numbers needed to harm.

Conclusions:

• The study identified potential prescribing cascades associated with DHP-CCB use in older adults.
• These findings highlight known and potentially underrecognized adverse effects of DHP-CCBs.
• Further research is warranted to investigate the clinical implications and patient outcomes of these identified prescribing cascades.