ArticleJournal of the American Geriatrics Society2024
Identifying and quantifying potentially problematic prescribing cascades in clinical practice: A mixed-methods study.
Article in Journal of the American Geriatrics Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Prescribing Cascades: An Umbrella Review and Updated Systematic Review.Drugs & aging · 2026Pooled it
- Creating Awareness of preScribing Cascades and Managing Adverse Drug Effects (CASC-ADE) Tool: Appraisal by Future End Users.Drugs & aging · 2026Article
- Appropriateness over Numbers: Pharmacological Burden and Scalable Medication Review in Older Adults.Geriatrics (Basel, Switzerland) · 2026Review
- Prescribing cascades among hospitalized older adults: a retrospective cohort study from the REPOSI registry.Internal and emergency medicine · 2026Observational
- Prescribing cascades potentially associated with harms before and after transition to long-term care facilities.Age and ageing · 2026Article
- Dose-dependent relationships in potential prescribing cascades: a cohort study using community pharmacy dispensing data.International journal of clinical pharmacy · 2026Article
- Dihydropyridine Calcium Channel Blocker-induced Prescribing Cascades: Signal Detection using High-throughput Sequence Symmetry Analysis.medRxiv : the preprint server for health sciences · 2026Article
- Prevalence and impact of prescribing cascades in community-dwelling adults: Longitudinal analysis of the Irish longitudinal study on ageing (TILDA).British journal of clinical pharmacology · 2026Article
- To include or not to include? A prescription from the pharmacy on how to use active learning-assisted screening in systematic reviews.Systematic reviews · 2026Article
- Characterising prescribing cascades in older community-dwelling adults attending general practice in The Netherlands: a retrospective cohort study.BMC primary care · 2026Article
- Predictors of a Gabapentinoid-Loop-Diuretic Prescribing Cascade in U.S. Nursing Home Residents.Journal of the American Geriatrics Society · 2026Article
- Occurrence of Potential Prescribing Cascades After Hospital Discharge: A Cohort Study.Pharmacoepidemiology and drug safety · 2026Article
- Decision-Making and Downstream Outcomes of the Gabapentinoid-Diuretic Prescribing Cascade.JAMA network open · 2025Article
- High-Throughput Screening for Prescribing Cascades Among Real-World Angiotensin-II Receptor Blockers (ARBs) Initiators.Pharmacotherapy · 2025Article
- Loop diuretics and subsequent use of urinary symptom medications in older adults: evaluation of a possible prescribing cascade.The journals of gerontology. Series A, Biological sciences and medical sciences · 2025Article
- Real-World Complexity of Prescribing Cascades.Basic & clinical pharmacology & toxicology · 2025Review
- Balancing polypharmacy and comorbidity management: cardiovascular health.Current opinion in HIV and AIDS · 2025Review
- Pharmacy-led interventions to reverse and prevent prescribing cascades in primary care: a proof-of-concept study.International journal of clinical pharmacy · 2025Article
- High-Throughput Screening for Prescribing Cascades Among Real-World Angiotensin-II Receptor Blockers (ARBs) Initiators.medRxiv : the preprint server for health sciences · 2025Article
- High-Throughput Screening for Prescribing Cascades Among Real-World Angiotensin-Converting Enzyme Inhibitor Initiators.Pharmacoepidemiology and drug safety · 2025Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundA prescribing cascade occurs when medication causes an adverse drug reaction (ADR) that leads to the prescription of additional medication. Prescribing cascades can cause excess medication burden, which is of particular concern in older adults. This study aims to identify and quantify potentially problematic prescribing cascades relevant for clinical practice.
methodsA mixed-methods study was conducted. First, prescribing cascades were identified through literature search. An expert panel (n = 16) of pharmacists and physicians assessed whether these prescribing cascades were potentially problematic. Next, a cohort study quantified potentially problematic prescribing cascades in adults using Dutch community pharmacy data for the period 2015-2020. Additionally, the influence of multiple medications potentially causing the same ADR was evaluated. Prescription sequence symmetry analysis was used to calculate adjusted sequence ratios (aSRs), adjusting for temporal prescribing trends. An aSR >1.0 indicates the occurrence of a prescribing cascade. In a subgroup analysis, aSRs were calculated for older adults.
resultsSeventy-six prescribing cascades were identified in literature and three were provided by experts. Of these, 66 (83.5%) were considered potentially problematic. A significant positive aSR for the medication sequence was found for 41 (62.1%) of these prescribing cascades. The highest aSR was found for amiodarone potentially causing hypothyroidism treated with thyroid hormones (4.63 [95% confidence interval 4.40-4.85]), based on 565 incident users. The biggest population (n = 34,645) was found for angiotensin converting enzyme-inhibitors potentially causing urinary tract infections treated with antibiotics. Regarding four potential ADRs, the aSRs were higher for people using multiple medications that cause the same ADR as compared to people using only one of those medications. Among older adults the aSRs remained significant for 37 prescribing cascades.
conclusionAn overview was generated of potentially problematic prescribing cascades relevant for clinical practice. These results can support healthcare providers to intervene and reduce medication burden for older adults.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.