Evidence map›Paper›PMID 40457590›Full record

ReviewBasic & clinical pharmacology & toxicology2025

Real-World Complexity of Prescribing Cascades.

J T H Nielen, K van der Walle, S H Spronk, F J H Magdelijns, P Denig, F Karapinar-Çarkıt

Abstract readReview
In one paragraph

Review in Basic & clinical pharmacology & toxicology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

J T H NielenDepartment of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands.ORCID https://orcid.org/0000-0002-3633-2504
K van der WalleDepartment of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands.
S H SpronkDepartment of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands.
F J H MagdelijnsCARIM, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
P DenigDepartment of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, The Netherlands.
F Karapinar-ÇarkıtDepartment of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

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.

Indexed as

Drug-Related Side Effects and Adverse ReactionsPractice Patterns, Physicians'DeprescriptionsDrug PrescriptionsHumansPolypharmacydeprescribingprescribing cascadesrational pharmacotherapysafety evaluationsafety pharmacology

Identifiers

PMID40457590
PMCPMC12130616

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Registered trials

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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.