Overview
Prescribing cascade occurs when a drug is prescribed to manage perceived side effects of another drug, often misinterpreting these side effects as new medical conditions, leading to additional medications and potential health risks, particularly in older adults 12.Diagnosis
Identification of initial drug causing adverse effects.
Misinterpretation of adverse effects as new medical conditions.
Subsequent prescription of additional medications to treat these misinterpreted symptoms 12.Management
Review and potentially discontinue unnecessary medications identified in the cascade.
Tailor treatment plans to address underlying conditions directly rather than symptomatic relief 1.Special Populations
Elderly: Higher risk due to polypharmacy and multiple comorbidities; careful medication review essential 1.Key Recommendations
Implement a multidisciplinary approach to identify and manage prescribing cascades in older adults (Evidence: Expert opinion) 1.
Use tools like ThinkCascades to screen for clinically important prescribing cascades affecting older individuals (Evidence: Expert opinion) 1.
Regularly assess and adjust medication regimens to minimize the risk of prescribing cascades, especially in patients with complex medication histories (Evidence: Expert opinion) 1.References
1 McCarthy LM, Savage R, Dalton K, Mason R, Li J, Lawson A et al.. ThinkCascades: A Tool for Identifying Clinically Important Prescribing Cascades Affecting Older People. Drugs & aging 2022. link
2 Ponte ML, Wachs L, Wachs A, Serra HA. Prescribing cascade. A proposed new way to evaluate it. Medicina 2017. link