New tool to help recognize common prescribing cascades

University of Toronto researchers have developed a tool to help prescribers identify and avoid common prescribing cascades, an under-recognized contributor to polypharmacy in the elderly. Prescribing cascades happen when medications are prescribed to manage symptoms thought to be due to a new condition, but are actually adverse effects of other medications, explained Lisa McCarthy, associate professor at the Leslie Dan Faculty of Pharmacy at the University of Toronto. “Sometimes it makes sense to introduce a new drug to treat side-effects of another, but sometimes the prescriber doesn’t recognize that what they are seeing is, in fact, a drug-induced effect, and this can lead to inappropriate and potentially harmful prescribing,” she said in a press release. Previous research by McCarthy and colleagues suggested that physicians and other healthcare providers often have trouble identifying prescribing cascades in their practice. The research, published in 2020 in BMC Geriatrics, concluded that more strategies are needed to identify and prevent prescribing cascades. The new tool is called ThinkCascades. It’s a simple table covering nine prescribing cascades that often occur when treating older patients with conditions such as anxiety, insomnia, hypertension or urinary incontinence. These prescribing cascades could leave patients paying for more medications than needed and at risk of drug-drug interactions. For example, a patient on a diuretic may have urinary incontinence as a side effect, which prompts the prescriber to suggest overactive bladder medication. Or, a patient taking a selective serotonin reuptake inhibitor (SSRI) develops insomnia as a side effect, which leads to a prescriber offering a sleep agent, such as a benzodiazepine. A paper on the development of the ThinkCascades tool was published in Drugs & Aging in September. It outlines the process to develop the tool, which involved a multidisciplinary panel of 38 clinicians from six countries. “By identifying nine clinically important prescribing cascades, this tool helps clinicians recognize other prescribing cascades when managing polypharmacy,” said Paula Rochon, lead author of the paper, professor in the department of medicine in the Temerty Faculty of Medicine and founding director of the Women’s Age Lab based at Women’s College Hospital in Toronto. “If we adjust our thinking to focus attention on raising awareness about prescribing cascades when reviewing medications, we can then work towards optimizing therapies and reducing medication harm for older adults, particularly women,” she said, in a press release. Read: Older adults with polypharmacy at risk of drug-drug interactions with nirmatrelvir-ritonavir

New tool to help recognize common prescribing cascades

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