Hickman E, Gillies C, Khunti K, Seidu S. Deprescribing, Polypharmacy and Prescribing Cascades in Older People with Type 2 Diabetes: A Focused Review. Journal of the Indian Institute of Science. 2023; 103:(4)

Hsin-Min Wang G, Morris EJ, Smith SM, Hallas J, Vouri SM. Continued potassium supplementation use following loop diuretic discontinuation in older adults: An evaluation of a prescribing cascade relic. J Am Geriatr Soc. 2023; 71:(2)505-515

Vouri SM, Morris EJ, Walsh M High-throughput screening for prescribing cascades among real world statin initiators. Pharmacoepidemiol Drug Saf. 2023; 32:(7)773-782

Prescribing cascades

02 December 2023
Volume 5 · Issue 12


Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided

Last month, the research round-up provided you with an overview of articles looking at prescribing in various aspects of cancer care. This month, we will review three articles looking at the issue of prescribing cascades. The first looks at known and potential prescribing cascades after the initiation of statin therapy. The second article looks at prescribing cascades in the elderly with type 2 diabetes. Finally, we look at continuation of potassium supplementation in the elderly following discontinuation of loop diuretics.

This research, published in the Journal of Pharmacoepidemiology and Drug Safety sought to implement a high-throughput signal detection programme using a sequence symmetry analysis to identify potential statin-related prescribing cascades.

Statins are one of the most prescribed drugs, with known associated adverse events that can lead to additional medications being prescribed and be the start of a prescribing cascade. The researchers obtained their data for inclusion from insurance databases in the USA and looked at records between 2005 and 2012 inclusive. The team used high-throughput analysis to assess timings of drug initiation of the statin and then compare with initiation of other medications that may be considered as secondary markers. Inclusion was patients aged 20 or over at commencement of statin and who had taken them for greater that 720 days. This yielded 2 265 519 individuals who had been commenced on statins in the study period. Demographic analysis revealed that there was a mean age of 56.4 years, with 48.7% being female. Of the cohort, 7.5% had identified cardiovascular disease and simvastatin was the most commonly prescribed drug with atorvastatin a close second.

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