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):745-752. doi: 10.3238/arztebl.m2022.0306.
A 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.
This review is based on pertinent publications retrieved by a selective literature search.
The 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?
Prescribing 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.
药物处方瀑布是指用另一种药物来治疗药物不良反应（ADR）。在这篇综述中，我们讨论了（a）不同类型的药物处方瀑布，以及（b）可以采取哪些措施来识别和妥善处理它们，无论是在医院还是在门诊环境中。
本综述基于通过选择性文献检索获得的相关出版物。
文献区分了有意和无意的药物处方瀑布，以及适当和不适当的药物处方瀑布。我们进一步区分了预防性和治疗性的药物处方瀑布，并在必要和仅仅适当之间划清界限。以下是正确处理药物处方瀑布的关键问题：（1）引发药物是否导致了临床相关的 ADR 或 ADR 风险？（2）引发药物是否仍然适用？（3）通过改变引发药物的治疗方法，或者（4）改用其他药物，能否避免 ADR？（5）用于治疗 ADR 的药物实际上能否对其产生有益的影响？（6）药物处方瀑布的益处是否超过其风险？
药物处方瀑布本身并不是问题；相反，它们有时是良好药物处方实践的必要组成部分。目前仍然缺乏实用的工具来帮助医生可靠地发现药物处方瀑布，对其进行适当评估，并将其合理应用。
