{"id":668221,"date":"2026-10-28T22:06:24","date_gmt":"2026-10-28T22:06:24","guid":{"rendered":"https:\/\/www.newsbeep.com\/ie\/668221\/"},"modified":"2026-10-28T22:06:24","modified_gmt":"2026-10-28T22:06:24","slug":"the-prescribing-cascade-the-error-of-treating-side-effects-with-more-drugs-health","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/ie\/668221\/","title":{"rendered":"The prescribing cascade: the error of treating side effects with more drugs | Health"},"content":{"rendered":"

Marta Tello is a 23-year-old pharmacist who works in Algete, in the Madrid region of Spain. Six months ago, while completing her training with a primary care team in Seville, she encountered a clinical case that she says she will remember throughout the professional career she is just beginning: \u201cThis person was taking 18 different medications, something striking even for an 80-year-old<\/a> with multiple underlying conditions. When we reviewed the case, we identified several prescribing cascades that needed to be reassessed,\u201d she says.<\/p>\n

The patient had been prescribed an antidepressant<\/a> (venlafaxine) that at high doses raises blood pressure, for which an antihypertensive had been prescribed. He was also taking hydrocortisone \u2014which can increase blood glucose<\/a>\u2014 so physicians were about to prescribe an antidiabetic. \u201cThese cascades occur when a drug\u2019s side effect is treated as if it were a new health problem. Instead of reviewing the prescription that caused the adverse effect, another drug is prescribed that may be unnecessary and could have serious clinical consequences for the patient,\u201d she explains.<\/p>\n

A study by Tello on this clinical case received an award at a recent congress of the General Council of Pharmaceutical Associations, held in Oviedo, Spain. The accolade illustrates the growing concern among health professionals, scientific societies and government agencies about therapeutic cascades, a risk that becomes more frequent \u201cas the population ages<\/a> and chronic health problems \u2014and the medications used to treat them\u2014 increase,\u201d says Carlos Fern\u00e1ndez Moriano, deputy director of Training and Professional Services at the Council.<\/p>\n

\"\"Marta Tello, at the Gonz\u00e1lez P\u00e9rez pharmacy where she works in Algete, Madrid.Samuel S\u00e1nchez<\/p>\n

Catalonia has now become the first region of Spain to launch a campaign aimed at professionals and the public to raise awareness about a trend that contributes to increasing problems caused by drugs. \u201cBetween 5% and 10% of hospitalizations are related to adverse drug reactions, and almost half of these cases could be prevented,\u201d the Catalan Ministry of Health notes.<\/p>\n

Periodic review<\/p>\n

Anna Coma, head of the Territorial Action Division in the Medication Area of the Catalan Health Service (CatSalut), stresses the importance of a \u201cperiodic review\u201d of medication to distinguish between cascades that pose a danger to the patient and those that may be justified. \u201cA typical example is constipation from iron supplements. The doctor already knows this is a common side effect and may also prescribe a laxative if they consider the risk\u2013benefit balance favorable for the patient. What matters is that decisions are based on such assessments and not on a confusion,\u201d she explains.<\/p>\n

The awareness campaign materials include about 20 potentially dangerous prescribing cascades. One can occur with the use of statins, drugs used to lower cholesterol. In some patients, they cause agitation or confusion, which can lead a physician to prescribe an unnecessary antipsychotic. In others they cause insomnia, which can end with a prescription for sleeping pills.<\/p>\n

Another example involves nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or diclofenac. These molecules \u2014used for pain, inflammation and fever\u2014 can raise blood pressure and lead to an erroneous diagnosis of hypertension and the prescription of a drug to treat it, when it would be preferable to replace the NSAID with another medication.<\/p>\n

The Catalan health campaign warns that prescribing cascades not only increase the use of unnecessary drugs but also \u201cmultiply the risk of new adverse effects and interactions,\u201d and \u201coverload the health system and the patient with extra doctor visits, diagnostic tests, emergency visits and avoidable hospital admissions.\u201d<\/p>\n

\"\"A family doctor reviews a patient\u2019s medications with her at a health center in Barcelona.Massimiliano Minocri<\/p>\n

The experts consulted by this newspaper agree on certain moments when a prescribing cascade is more likely to begin. One is a visit to an emergency room for an acute episode, explains Daniel Sevilla of the Spanish Society of Hospital Pharmacy (SEFH). \u201cThe priority in these cases is resolving a life-threatening problem, which may require a new drug. Because any adverse effects it may cause will take days or weeks to appear, it will be harder to identify the drug as the cause of the symptoms, and the patient may be prescribed another drug to treat them,\u201d he describes.<\/p>\n

Care fragmentation<\/p>\n

Another factor that facilitates cascades is so-called \u201ccare fragmentation,\u201d which occurs when a patient sees multiple specialists who diagnose and treat conditions within their own area of expertise without coordinating with others. This situation gives primary care a key role in identifying and preventing these problems. \u201cContinuity of care is very important. We know the patient\u2019s history and whether they have had similar episodes in the past. So we can more easily see if a recent change in medication might be causing problems,\u201d says Mariam de la Poza, Catalan president of the Spanish Society of General Practitioners and Family Physicians (SEMG).<\/p>\n

At the hospital level, services such as internal medicine most often face these cases. \u201cA major obstacle with prescribing cascades is that they can go unnoticed and are very difficult to identify if the physician does not keep this possibility in mind and does not thoroughly review all treatments,\u201d explains Virginia Gracia of the Spanish Society of Internal Medicine (SEMI).<\/p>\n

She illustrates this with an example: \u201cA very alarming symptom is sudden weight loss in an older person. It can suggest serious illnesses, even cancer<\/a>, which sometimes leads to diagnostic tests and new treatments and causes great concern for the patient and their family. I have seen cases where, in the end, everything was due to digestive changes caused by an iron supplement.\u201d<\/p>\n

Sign up for our weekly newsletter<\/a> to get more English-language news coverage from EL PA\u00cdS USA Edition<\/p>\n","protected":false},"excerpt":{"rendered":"Marta Tello is a 23-year-old pharmacist who works in Algete, in the Madrid region of Spain. Six months…\n","protected":false},"author":2,"featured_media":668222,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[33],"tags":[283018,4096,1702,103,61,60,371,283019],"class_list":["post-668221","post","type-post","status-publish","format-standard","has-post-thumbnail","category-medication","tag-algete","tag-barcelona","tag-diabetes","tag-health","tag-ie","tag-ireland","tag-medication","tag-oviedo"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/668221","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/comments?post=668221"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/668221\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media\/668222"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media?parent=668221"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/categories?post=668221"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/tags?post=668221"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}