Prescribing cascades: how to detect them, prevent them, and use them appropriately

Dreischulte, Tobias; Shahid, Faiza; Muth, Christiane; Schmiedl, Sven; Haefeli, Walter E.

doi:10.3238/arztebl.m2022.0306

Cited by 5 publications

(5 citation statements)

References 67 publications

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“…Similarly, the use of thyroxine to manage amiodarone‐induced hypothyroidism will often be necessary since there are limited alternatives to amiodarone in the management of ventricular tachyarrhythmias 56 . Prescribing cascades are therefore not inappropriate per se but may be appropriate or even necessary when the index drug is indispensable and the adverse reaction caused by it requires treatment or prevention 57,58 . In addition to potentially inappropriate prescribing cascades, further research should aim to systematically identify and build consensus around necessary prescribing cascades.…”

Section: Discussionmentioning

confidence: 99%

“…56 Prescribing cascades are therefore not inappropriate per se but may be appropriate or even necessary when the index drug is indispensable and the adverse reaction caused by it requires treatment or prevention. 57,58 In addition to potentially inappropriate prescribing cascades, further research should aim to systematically identify and build consensus around necessary prescribing cascades.…”

Section: Implications For Clinical Practice and Researchmentioning

confidence: 99%

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Prescribing cascades in ambulatory care: A structured synthesis of evidence

Shahid,

Doherty,

Wallace

et al. 2023

Pharmacotherapy

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ImportanceThe strength of evidence for specific ambulatory care prescribing cascades, in which a marker drug is used to treat an adverse event caused by an index drug, has not been well characterized.ObjectiveTo perform a structured, systematic, and transparent review of the l evidence supporting ambulatory care prescribing cascadesDesign, setting, and participantsNinety‐four potential prescribing cascades identified through a previously published systematic review. Systematic search of the literature to further characterise prescribing cascades.Main outcome(1) Grading of evidence based on observational studies investigating associations between index and marker drugs, including: Level I ‐ strong evidence [i.e. multiple high‐quality studies]; Level II ‐ moderate evidence [i.e. single high‐quality study]; Level III ‐ fair evidence [no high‐quality studies but one or more moderate‐quality studies]; and Level IV ‐ poor evidence [other]. (2) Listing of the adverse event associated with the index drug in the product's United States Food and Drug Administration (FDA) label. (3) Synthesis of the evidence supporting mechanisms linking index drugs and associated adverse events.ResultsOf 99 potential cascades, 94 were supported by one or more confirmatory observational studies and were therefore included in this review. The 94 cascades related to 30 types of adverse drug reactions affecting 10 different anatomic/physiologic systems and were investigated by a total of 88 confirmatory studies, including prescription sequential symmetry analysis (n=51), cohort (n=30), and case‐control (n=7) studies. Overall, the evidence from observational studies was strong for 18 (19.1%) prescribing cascades, moderate for 61 (64.9%), fair for 13 (13.8%), and poor for 2 (2.1%). Although the evidence supporting mechanisms that link index drugs and associated adverse events was variable, FDA labels included information about the adverse event associated with the index drug for most (n=86) but not all of the 94 prescribing cascades.ConclusionsAlthough we identified 18 of 94 prescribing cascades supported by strong clinical evidence and most adverse events associated with index drugs are included in FDA label, the evidentiary basis for prescribing cascades varies, with many requiring further evidence of clinical relevance.

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Section: Discussionmentioning

confidence: 99%

Section: Implications For Clinical Practice and Researchmentioning

confidence: 99%

Prescribing cascades in ambulatory care: A structured synthesis of evidence

Shahid,

Doherty,

Wallace

et al. 2023

Pharmacotherapy

Self Cite

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“…Национальное руководство Evidence-based pharmacotherapy in cardiology. National guideline фекты), а также так называемый каскад назначения (prescribing cascades) -назначение ЛП для лечения побочных эффектов других ЛС [299]. Следует иметь в виду, что понятие ННЛ используется в первую очередь у пожилых больных, что, в первую очередь, связывают с наличием у них мультиморбидности.…”

Section: нерациональное назначение лекарственных препаратовunclassified

Evidence-based pharmacotherapy in cardiology. National guideline

Martsevich,

Kutishenko,

Lukina

et al. 2024

Racionalʹnaâ farmakoterapiâ v kardiologii

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“…Thus, when the cause of pruritus was not ascertained to be a drug, a new drug was prescribed. This medical phenomenon is referred to as a "prescribing cascade," in which the side effects of one drug were erroneously diagnosed as a new disease, resulting in the prescription of yet another new drug [47]. When occurring repeatedly, this process resulted in patients taking numerous unnecessary medications, which could lead to additional health problems.…”

Section: Limitationsmentioning

confidence: 99%

Comprehensive Study of Drug-Induced Pruritus Based on Adverse Drug Reaction Report Database

Nakao,

Asada,

Uesawa

2023

Pharmaceuticals

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Drug-induced pruritus triggers a desire to scratch, thereby diminishing one’s quality of life. Certain instances of this phenomenon follow complex mechanisms of action that diverge from histamine-mediated pathways, known contributors to pruritus. However, investigations into the relationship between drugs and pruritus are limited. In this study, data mining techniques were employed to comprehensively analyze the characteristics of drugs linked to pruritus, using the FDA’s Adverse Event Reporting System (FAERS) data. Reports linked to pruritus demonstrated noteworthy differences in gender, age, and weight when compared with non-pruritus cases. Among the leading candidates for drugs prompting pruritus were ophthalmic drugs, systemic antibacterials, contrast media, dermatological antifungals, and dermatological preparations. A principal component analysis showed that the second principal component served as an indicator for distinguishing between onsets at mucous membranes or the skin’s surface. Additionally, the third principal component functioned as an indicator for categorizing administration methods as either invasive or noninvasive. Furthermore, a hierarchical cluster analysis conducted on these obtained principal components revealed the potential for classifying drugs based on the site of pruritus onset and the method of drug administration. These findings contribute to the development of targeted prevention and treatment strategies for avoiding pruritus in clinical practice.

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Prescribing cascades: how to detect them, prevent them, and use them appropriately

Cited by 5 publications

References 67 publications

Prescribing cascades in ambulatory care: A structured synthesis of evidence

Prescribing cascades in ambulatory care: A structured synthesis of evidence

Evidence-based pharmacotherapy in cardiology. National guideline

Comprehensive Study of Drug-Induced Pruritus Based on Adverse Drug Reaction Report Database

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