On the Look Out for Prescribing Cascades

Authors:
Veronica Arceri, PharmD
Mallory Telese, BA, PharmD, BCACP

Reviewers:
Emily Prohaska, PharmD, BCACP
Stuart T Haines, PharmD, BCPS, BCACP

Citation:
Read SH, Giannakeas V, Pop P, et al. Evidence of a gabapentinoid and diuretic prescribing cascade among older adults with lower back pain. J Am Geriatr Soc. 2021;69(10):2842-2850. doi:10.1111/jgs.17312 

The Problem

Is my patient’s forgetfulness due to dementia or diphenhydramine? In older adults, adverse drug events (ADEs) can often be misinterpreted and lead to the initiation of new medications, which carry their own risks of ADEs … that can be misinterpreted as a new problem … leading to even more medications being prescribed. This avoidable chain of events, called a prescribing cascade¹, significantly increases medication burden and healthcare costs.  But it can be mitigated through increased awareness and diligent medication reviews.