• Dtsch Arztebl Int · Nov 2022

    Review

    Prescribing Cascades: How to Detect Them, Prevent Them, and Use Them Appropriately.

    • Tobias Dreischulte, Faiza Shahid, Christiane Muth, Sven Schmiedl, and Walter Emil Haefeli.
    • Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich; Department of General Practice and Family Medicine, Medical Faculty OWL, University of Bielefeld; Philipp Klee-of Clinical Pharmacology, Helios Clinic Wuppertal; Clinical Pharmacology, Witten/Herdecke University, Witten/Herdecke; Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelbergg.
    • Dtsch Arztebl Int. 2022 Nov 4; 119 (44): 745752745-752.

    BackgroundA prescribing cascade is the treatment of an adverse drug reaction (ADR) with another drug. In this review, we discuss (a) the different types of prescribing cascade and (b) the measures that can be taken so that they will be recognized and dealt with appropriately, both in the hospital and in the outpatient setting.MethodsThis review is based on pertinent publications retrieved by a selective literature search.ResultsThe literature distinguishes intentional from unintentional prescribing cascades, and appropriate from inappropriate ones. We further distinguish prophylactic from therapeutic prescribing cascades and draw a line between those that are necessary and those that are merely appropriate. The following main questions are essential for dealing with prescribing cascades appropriately: (1) Did the precipitating drug cause a clinically relevant ADR or risk of an ADR? (2) Is the precipitating drug still indicated? (3) Can an ADR be avoided by altering the treatment with the precipitating drug, or by (4) switching to another drug instead? (5) Can the drug used to treat the ADR actually affect it beneficially? (6) Do the benefits of the prescribing cascade outweigh its risks?ConclusionPrescribing cascades are not problematic in themselves; on the contrary, they are sometimes a necessary part of good prescribing practice. There is still a lack of practically implementable instruments to help physicians detect prescribing cascades reliably, assess them properly, and put them to appropriate use.

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