Examples of prescribing cascades

Initial drug therapy	Adverse drug event	Subsequent drug therapy
Antipsychotics	Extrapyramidal signs and symptoms	Antiparkinsonian therapy
Cholinesterase inhibitors	Urinary incontinence	Incontinence treatment
Thiazide diuretics	Hyperuricemia	Gout treatment
NSAIDs	Increased blood pressure	Antihypertensive therapy

Medication prescribing cascades occur when patients are prescribed medications to treat the adverse side effects of previously prescribed medications. This leads to polypharmacy and further increases the risk for adverse drug events. Periodic review of medication lists, especially in older adults, can minimize this risk.

NSAIDs: nonsteroidal antiinflammatory drugs.

Data from:

Rochon PA, Gurwitz JH. Optimizing drug therapy for elderly people: the prescribing cascade. BMJ 1997; 315:1096.
Gill SS, Mamdani M, Naglie G, et al. A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. Arch Intern Med 2005; 165:808.

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Examples of prescribing cascades