Prescribing Cascade Study Lists 24 Drug Combinations Worth Reviewing

A new BMJ study has identified 24 medication patterns where one drug prescribed to treat side effects of another may itself cause harm — and researchers say the list could help doctors and patients review prescriptions more carefully.

A study published in the BMJ has produced a ranked list of 24 so-called prescribing cascades — situations where a patient is given a second medicine to treat side effects caused by a first, without always recognising the connection. The research suggests these patterns are common enough to warrant targeted action from prescribers and from those working to reduce unnecessary medication in older patients.

A prescribing cascade happens when, for example, a drug causes a side effect such as high blood pressure or nausea, and a clinician then prescribes another drug to treat that symptom rather than reconsidering the original medicine. Over time, patients can end up on several medications, each added to manage the effects of the last.

The BMJ study prioritised the 24 cascades most likely to cause harm, giving clinicians a practical starting point for review. According to the research, having a defined list could inform both prescribing decisions — choosing medicines less likely to trigger a cascade — and deprescribing, the deliberate process of reducing or stopping medicines that are no longer appropriate.

Deprescribing is a growing area of clinical interest, above all for older patients who are more likely to be taking multiple medicines at once — a situation known as polypharmacy. But the challenge has always been knowing where to start. A prioritised list gives GPs and pharmacists a clearer framework.

For patients in Kent, this kind of research feeds into NHS-wide efforts to review long-term prescriptions and reduce medication burden where it is safe to do so. NHS Kent and Medway has previously supported medicines review programmes as part of broader care planning for patients on complex drug regimens.

Key information

• If you are concerned about medicines you or a family member are taking, speak to your GP or community pharmacist
• NHS 111 can advise on medication queries at any time of day or night
• Do not stop taking prescribed medication without speaking to a clinician first