“Prescribing cascades” happen when one remedy is used to deal with or forestall a facet impact of one other remedy. An unintentional cascade can come up when a affected person’s signs are mistaken for a brand new sickness. In that case, the affected person not solely experiences the unique facet impact but additionally faces added dangers from the second remedy.
Researchers at University College Cork in Cork, Ireland, analyzed nationwide prescription information for 533,464 community-dwelling Irish adults aged 65 years and older, masking prescriptions allotted from 2017 to 2020. The findings are published in The Annals of Family Medicine journal.
A prescription sequence symmetry evaluation was carried out inside a 365-day window to look at 9 expert-defined prescribing cascades often known as “AssumeCascades.” Researchers examined allotted prescription information just for potential prescribing cascades.
Main outcomes
Out of the 9 prescribing cascades examined, 5 had vital optimistic adjusted sequence ratios, indicating that the affected person was extra more likely to obtain the primary remedy earlier than the second remedy:
- Calcium channel blocker resulting in diuretic prescribing
- Alpha-1-receptor blocker resulting in vestibular sedative prescribing
- Selective serotonin reuptake inhibitor (SSRI) or selective norepinephrine reuptake inhibitor (SNRI) resulting in sleep agent prescribing
- Benzodiazepine resulting in antipsychotic prescribing
- Antipsychotic resulting in anti-Parkinsonian agent prescribing
Three different drug pairs confirmed vital destructive associations, indicating that the affected person was much less more likely to obtain the primary remedy earlier than the second remedy:
- Diuretic to overactive bladder remedy
- Benzodiazepine to antidementia agent
- Nonsteroidal anti-inflammatory medication (NSAIDs) to antihypertensive remedy
For clinicians, together with opposed drug reactions among the many doable causes to verify or exclude when sufferers present with new signs in major care is a vital step in figuring out and mitigating medication-related hurt.
More data:
Ann Sinéad Doherty et al, Prescribing Cascades Among Older Community-Dwelling Adults: Application of Prescription Sequence Symmetry Analysis to a National Database in Ireland, The Annals of Family Medicine (2025). DOI: 10.1370/afm.240383
Citation:
Study reveals 5 remedy ‘prescribing cascades’ that will put older adults in danger ( 29)
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