2023-09-17 18:58:00
Some medications are particularly likely to lead to cascades of prescriptions of other medications to manage their side effects.
This often occurs when these effects are misinterpreted as the onset of a new disease condition rather than being recognized as side effects.
“It is sometimes appropriate to introduce a new drug to treat the side effects of another, but sometimes the prescriber does not recognize that what they are observing is in fact a drug-induced effect,” explains Lisa McCarthy of the University of Toronto Faculty of Medicine.
Ms. McCarthy and her colleagues conducted a literature search to compile a list of clinically important prescription cascades that have a negative effect, particularly as we age. Their results were published in September 2022 in the journal Drugs & Aging.
They identified 139 drug cascades which were then analyzed by a panel of 38 clinicians from six countries according to the frequency of prescription, the severity of potential adverse effects, the availability of therapeutic alternatives, etc.
At the end of this process, 9 cascades were considered particularly problematic in older adults treated for common conditions such as anxiety, insomnia, hypertension or urinary incontinence.
Here is an example of a cascade: edema caused by a blood pressure medication is treated with a diuretic; urinary incontinence caused by the diuretic is treated with an anticholinergic (or atropinic) medication; which leads to cognitive disorders which may lead to the prescription of other medications.
The nine most problematic drug cascades identified are as follows. Several of these cascades can be linked to each other.
Cardiovascular system
Hypertension medications from the calcium channel blocker class
– Side effect: edema (feet, legs, etc.)
– Medicines that treat the side effect: diuretics
Hypertension medications from the diuretic class
– Side effect: urinary incontinence
– Medicines that treat the side effect: medicines for overactive bladder
Central nervous system
Antipsychotic medications
– Side effects: extrapyramidal symptoms (tremor, movement disorders, etc.)
– Medicines that treat side effects: antiparkinsonian agents.
Anxiolytics of the benzodiazepine class (e.g. Xanax, Lexomil, Valium) (list)
– Side effect: cognitive disorders
– Medicines that treat the side effect: cholinesterase inhibitor medicines (Aricept, Reminyl, Exelon) or Ebixa.
Benzodiazepine anxiolytics
– Side effect: Paradoxical agitation or agitation secondary to withdrawal
– Medications that treat the side effect: antipsychotics.
SSRI antidepressants and SNRI antidepressants
– Side effect: insomnia
– Medications that treat the side effect: benzodiazepines, benzodiazepine receptor agonists, sedative antidepressant, melatonin, etc.
Musculoskeletal system
Medications: non-steroidal anti-inflammatory drugs (NSAIDs)
– Side effect: Hypertension
– Medications that treat the side effect: antihypertensive medications
Urogenital system
Anticholinergic (or atropinic) medications
urinary
– Side effect: Cognitive disorders
– Medicines that treat the side effect: cholinesterase inhibitors (Aricept, Reminyl, Exelon) or Ebixa.
Alpha-1 receptor blocker drugs
– Side effect: orthostatic hypotension, dizziness
– Medications that treat the side effect: vestibular sedatives (e.g. betahistine, antihistamines, benzodiazepines)
“When a new disorder is noticed, thinking that it may be an adverse effect of a medication can be of service to patients and save them from unnecessary new prescriptions,” underlines the journal Prescribe which relays this study.
For more information, see the links below.
Psychomedia with sources: Drugs & Aging, University of Toronto, Prescribe.
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