One medication can trigger a chain of new prescriptions

We are talking about so‑called potentially inappropriate prescribing cascades (PIPC): a situation where the body’s reaction to a medication is interpreted as a separate health problem, and in response, another prescription is added. One typical example is taking non‑steroidal anti‑inflammatory drugs (NSAIDs) to relieve pain. It is known that such medications can increase blood pressure, and instead of reviewing the initial therapy, the patient is often prescribed medication for hypertension. Thus, instead of eliminating the cause, an additional burden arises due to the new medication.

Elderly people are particularly vulnerable to such cascades, as due to the multitude of chronic conditions they often take several medications at once, and it can be difficult for both the doctor and the patient themselves to track which specific drug caused a new symptom. A special risk group consists of mature women; throughout their lives, they encounter a large number of chronic diseases, are more likely to receive medication prescriptions, and are more likely to experience adverse reactions to medications. Accordingly, the risk that a side effect will be mistaken for a new disease rather than linked to the medication already being taken is also higher.

To assess the scale of the problem, the research team assembled an interdisciplinary group of experts from the USA, Belgium, Italy, Israel, Ireland, and Canada. With the participation of 12 international specialists in internal medicine, geriatrics, and clinical pharmacology, the scientists had previously compiled a list of 65 potentially inappropriate prescription cascades. Then, using prescription data (from ICES — the Institute for Clinical Evaluative Sciences in Ontario), they analyzed each cascade using three parameters: how often the initial medication is prescribed, how often a second drug is prescribed after it, and how strong the proven link between them is. As a result, 24 cascades were identified that occur particularly frequently and pose the greatest potential harm.

According to Dr. Rochen, the main problem is that these chains of events often go unnoticed in everyday practice. It is important that at each appointment, the doctor not only records which medications the patient is currently taking, but also clarifies when and for what reason each of them was prescribed, and whether subsequent prescriptions were truly necessary.

Scientists propose several approaches to solving the problem. First, it involves the introduction of technological tools: clinical decision support systems can alert the doctor in real time if a new prescription might be part of an undesirable cascade. Second, it requires more active involvement of pharmacists in the therapy prescription process: their expertise helps identify suspicious chains and suggest options for revising the treatment regimen.

The point is not to abandon combination therapy, but to approach each new prescription consciously. Understanding which side effects are most common will allow doctors to identify risks in advance and discuss with patients not only current symptoms but also the history of prescriptions, so that the treatment actually helps and does not create new problems.