Polypharmacy is one of the most common—and often overlooked—challenges in modern healthcare, especially in older adults. It’s not just about the number of medications a patient is taking, but whether each one still has a clear indication, is providing benefit, and isn’t causing harm. As medication lists grow, so does the risk of adverse effects, drug interactions, and something we see all the time in practice: the prescribing cascade.

A prescribing cascade happens when a medication causes a side effect that is misinterpreted as a new medical condition, leading to the addition of another drug. Over time, this can snowball into unnecessary complexity and increased risk for patients.

In part 2 of this podcast, we outline 5 more examples that I’ve encountered in my geriatric pharmacist practice.

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