Credits: 0.25 AMA PRA Category 1 Credit™

Overview: A prescribing cascade occurs when adverse effects of a medication are mistaken for a new condition and treated with additional drugs. Older adults experiencing polypharmacy are most at risk. The impact of prescribing cascades can be substantial, leading to falls, organ injury, unnecessary imaging and tests, and more. Join us as we explore how to recognize and prevent these harmful cascades in your patients.

Episode resource links:

Adrien  O, Mohammad  AK, Hugtenburg  JG,  et al.  Prescribing cascades with recommendations to prevent or reverse them: a systematic review.   Drugs Aging. 2023;40(12):1085-1100. doi:10.1007/s40266-023-01072-yPubMedGoogle ScholarCrossref

Brath  H, Mehta  N, Savage  RD,  et al.  What is known about preventing, detecting, and reversing prescribing cascades: a scoping review.   J Am Geriatr Soc. 2018;66(11):2079-2085. doi:10.1111/jgs.15543PubMedGoogle ScholarCrossref

Daunt R, McGettigan S, Kelly L, Curtin D, O'Mahony D. Detection of Potential Prescribing Cascades in Multimorbid Older Patients Hospitalised with Acute Illness-An Observational Prospective Prevalence Study. Drugs Aging. 2025;42(6):535-546. doi:10.1007/s40266-025-01201-9

Growdon ME, Tjota N, Campbell R, et al. Decision-Making and Downstream Outcomes of the Gabapentinoid-Diuretic Prescribing Cascade. JAMA Netw Open. 2025;8(12):e2545274. doi:10.1001/jamanetworkopen.2025.45274

McCarthy  LM, Savage  R, Dalton  K,  et al.  ThinkCascades: a tool for identifying clinically important prescribing cascades affecting older people.   Drugs Aging. 2022;39(10):829-840. doi:10.1007/s40266-022-00964-9PubMedGoogle ScholarCrossref

O’Mahony, D., Cherubini, A., Guiteras, A.R. et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med 14, 625–632 (2023). https://doi.org/10.1007/s41999-023-00777-y

Rochon, P.A., O’Mahony, D., Cherubini, A. et al. International expert panel’s potentially inappropriate prescribing cascades (PIPC) list. Eur Geriatr Med 16, 1573–1584 (2025). https://doi.org/10.1007/s41999-025-01215-x

Young EH, Pan S, Yap AG, Reveles KR, Bhakta K. Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016. PLoS One. 2021;16(8):e0255642. Published 2021 Aug 3. doi:10.1371/journal.pone.0255642

Guest: Susan Feeney, DNP, FNP-BC, NP-C

Thoughts? Suggestions? Email us at [email protected] 

The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.