Observational studyJournal of the American Pharmacists Association : JAPhA
An evaluation of a potential calcium channel blocker-lower-extremity edema-loop diuretic prescribing cascade.
Observational study in Journal of the American Pharmacists Association : JAPhA. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 3 syntheses or guidelines pooled it, 41 citations in OpenAlex.
- Prescribing Cascades: An Umbrella Review and Updated Systematic Review.Drugs & aging · 2026Pooled it
- Prescribing Cascades with Recommendations to Prevent or Reverse Them: A Systematic Review.Drugs & aging · 2023Pooled it
- Prescribing cascades in community-dwelling adults: A systematic review.Pharmacology research & perspectives · 2022Pooled it
- Dihydropyridine Calcium Channel Blocker-induced Prescribing Cascades: Signal Detection using High-throughput Sequence Symmetry Analysis.medRxiv : the preprint server for health sciences · 2026Article
- Prevalence and impact of prescribing cascades in community-dwelling adults: Longitudinal analysis of the Irish longitudinal study on ageing (TILDA).British journal of clinical pharmacology · 2026Article
- Occurrence of Potential Prescribing Cascades After Hospital Discharge: A Cohort Study.Pharmacoepidemiology and drug safety · 2026Article
- Prescribing Cascades Among Older Community-Dwelling Adults: Application of Prescription Sequence Symmetry Analysis to a National Database in Ireland.Annals of family medicine · 2025Article
- Real-World Complexity of Prescribing Cascades.Basic & clinical pharmacology & toxicology · 2025Review
- Amlodipine and frusemide: pharmacological factors contributing to increased fall risk in concurrently treated patients - a retrospective cross-sectional study.Frontiers in pharmacology · 2025Article
- Evaluating Provider and Pharmacy Discordance in Potential Calcium Channel Blocker-Loop Diuretic Prescribing Cascade.Drugs & aging · 2024Article
- Continued potassium supplementation use following loop diuretic discontinuation in older adults: An evaluation of a prescribing cascade relic.Journal of the American Geriatrics Society · 2023Article
- Research on prescribing cascades: a scoping review.Frontiers in pharmacology · 2023Article
- Prescribing Cascades: How to Detect Them, Prevent Them, and Use Them Appropriately.Deutsches Arzteblatt international · 2022Review
- "Kind of blurry": Deciphering clues to prevent, investigate and manage prescribing cascades.PloS one · 2022Article
- A Prescribing Cascade of Proton Pump Inhibitors Following Anticholinergic Medications in Older Adults With Dementia.Frontiers in pharmacology · 2022Article
- Differences in Health-Related Quality of Life Among Adults with a Potential Dihydropyridine Calcium Channel Blocker-Loop Diuretic Prescribing Cascade.Drugs & aging · 2021Article
- An examination of three prescribing cascades in a cohort of older adults with dementia.BMC geriatrics · 2021Article
- Antidopaminergic-Antiparkinsonian Medication Prescribing Cascade in Persons with Alzheimer's Disease.Journal of the American Geriatrics Society · 2021Article
- Prescribing cascades in community-dwelling adults: protocol for a systematic review.HRB open research · 2021Article
- Patient and provider perspectives on the development and resolution of prescribing cascades: a qualitative study.BMC geriatrics · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 2 institutions in 2 countries.
Funding
Abstract
objectivesDihydropyridine calcium channel blockers (DH-CCB) are associated with lower-extremity edema (LEE). Loop diuretics have been used inappropriately to treat DH-CCB-associated LEE, constituting a prescribing cascade (PC). The aim of this work was to identify the prevalence and factors associated with potential DH-CCB-LEE-loop diuretic PC.
methodsThe 2014 National Ambulatory Medical Care Survey was used to identify patient visits in which a DH-CCB was continued. The definition of a potential PC was the continuation or initiation of a loop diuretic in the absence of congestive heart failure, cancer, obstructive sleep apnea, chronic kidney disease or end-stage renal disease, obesity, or resistant hypertension. Multivariable logistic regression was used to identify factors related to a potential PC, including demographic information, number of medications, number of patient visits in the previous 12 months, and comorbid conditions.
resultsAmong the estimated 47.5 million patient visits in which a DH-CCB was continued, 4.6% had a potential PC. Visits in patients 65 to 84 years of age (odds ratio [OR] 2.56, 95% CI 1.20-5.43) and 85 years of age and older (OR 3.89, 95% CI 1.76-8.61) were more likely to have potential PC compared with patients 18 to 64 years of age. Visits in patients with 5 to 7 (OR 3.75, 95% CI 1.72-8.19), 8 to 11 (OR 2.20, 95% CI 1.09-4.44), and 12 or more (OR 5.23, 95% CI 2.29-11.94) medications were more likely to have potential PC compared with patients with 4 or fewer medications.
conclusionA potential DH-CCB-associated LEE loop diuretic PC was present in approximately 2.2 million patient visits in which DH-CCB was continued. Older age and an increasing number of concomitant medications were associated with this potential PC.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.