What is the prescribing cascade? It occurs when another medication is prescribed to combat the side effects of an initial medication.
We all want a quick fix in a pill. Constipation? Take a laxative. Headache? Ibuprofen or acetaminophen. Drug overdose? Narcan.
What happens when the initial medication causes side effects and the patient is prescribed more and more medications yet the side effect still persists? With the current healthcare trends, patients have multiple physicians and go to multiple pharmacies. Identifying a prescribing cascade has become more difficult.
This week’s case involved cholesterol medicine. The patient is taking an additional 5 tablets a day to combat cramping. The cholesterol numbers are very good (yes, I know it is due to the cholesterol med). The cardiovascular risk calculator estimates the risk of this patient having a heart attack in the next 10 years at 5%.
So what do you do? You weigh the risks versus benefits and discuss with your physician.
In the case above, the side effect of cramping still persists and is affecting the patient’s daily activities. She didn’t even realize it may have been a side effect of a medication and followed her physicians instructions as more and more pills were added to her regimen.
It was recommended that the patient check with her physician to see if he would allow her to discontinue the cholesterol medications for 3 months to see if the side effect of cramping disappears. She would also be able to discontinue the 5 additional pills that had been subsequently added. In 3 months, they would reevaluate the need for the medicine based on risks and lab testing. We know the cholesterol medication is effective; perhaps she could try a different cholesterol medication or restart on a lower dose to minimize the side effects.
Pharmacists see this on a daily basis. If you are experiencing a change in your health, medications could be the culprit. Before adding another pill to your regimen, discuss it with your pharmacist. If you do not have a ‘go to’ pharmacist that you can rely on, please reach out to us for a free get acquainted call.