Nielen J T H, van der Walle K, Spronk S H, Magdelijns F J H, Denig P, Karapinar-Çarkıt F
Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands.
CARIM, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
Basic Clin Pharmacol Toxicol. 2025 Jul;137(1):e70063. doi: 10.1111/bcpt.70063.
Prescribing cascades occur when an adverse drug reaction (ADR) to one medication is treated with additional medication. Most literature focusses on this simplistic singular concept of one medication followed by another. However, ADRs in clinical practice may appear less straightforward, making prescribing cascades difficult to identify and deprescribe. More insight is needed into the real-world complexity of prescribing cascades, since they may negatively impact both patients and the healthcare system. This article aims to provide exemplary cases of the real-world complexity of prescribing cascades and explores strategies to identify, mitigate and prevent them. The real-world cases discussed highlight the multifaceted nature of prescribing cascades in clinical practice. They show several factors contributing to the challenges in recognizing ADRs and preventing prescribing cascades, including misinterpretation of ADRs, fragmented healthcare systems and accumulation of pharmacological effects and comorbidities within an individual patient. Several strategies are recommended to improve identification, mitigation and prevention of prescribing cascades. Although educating patients and healthcare providers (HCPs) can help bridge the knowledge gap, additional strategies are needed. Implementing supportive tools to deprescribe, enhanced communication among HCPs and patients regarding ADRs and rationale for medication changes, and monitoring patients for ADRs are considered the most promising strategies.
当用额外的药物治疗对一种药物的药物不良反应（ADR）时，就会出现处方级联。大多数文献关注的是这种一种药物接着另一种药物的简单单一概念。然而，临床实践中的药物不良反应可能看起来不那么简单直接，这使得处方级联难以识别和停用。需要更深入地了解处方级联在现实世界中的复杂性，因为它们可能对患者和医疗保健系统都产生负面影响。本文旨在提供处方级联在现实世界中复杂性的示例案例，并探讨识别、减轻和预防它们的策略。所讨论的现实世界案例突出了临床实践中处方级联的多面性。它们显示了导致识别药物不良反应和预防处方级联面临挑战的几个因素，包括对药物不良反应的误解、医疗保健系统的碎片化以及个体患者体内药理作用和合并症的累积。建议采取几种策略来改进处方级联的识别、减轻和预防。虽然对患者和医疗保健提供者（HCPs）进行教育有助于弥合知识差距，但还需要其他策略。实施停用药物的支持工具、加强HCPs与患者之间关于药物不良反应和药物变更理由的沟通以及监测患者的药物不良反应被认为是最有前景的策略。
