Dose-dependent relationships observed for prescribing cascades: a cohort study

Dose-dependent relationships observed for prescribing cascades: a cohort study | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 5 May 2025 V1 Latest version Share on Dose-dependent relationships observed for prescribing cascades: a cohort study Authors : Ruveyda Gündogan-Yilmaz 0009-0008-5054-4504 , Sadaf Wahedi , J.H.M. Driessen , Atiya Mohammed , Petra Denig 0000-0002-7929-4739 , and Fatma Karapinar-Çarkit [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.174643575.50252167/v1 343 views 200 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: Prescribing cascades occur when new medications are initiated to treat adverse drug reactions (ADRs) caused by an initial medication (index). Although dose reduction of the index medication is often recommended, evidence supporting a dose-dependent relationship is limited. Objectives: To investigate dose-dependent relationships in prescribing cascades where such evidence is currently insufficient or lacking. Methods: A cohort study was conducted using prescription sequence symmetry analysis with data from over 600 Dutch community pharmacies. We assessed 18 prescribing cascades involving ACE inhibitors (ACEIs), statins, antidepressants, calcium channel blockers, and other drug classes. Index medication doses were categorized based on the WHO Defined Daily Dose (DDD) into low (1.50 DDD). Adjusted sequence ratios (aSRs) were calculated per dose category; aSRs >1 indicated the presence of a prescribing cascade. Results: Twelve of the 18 prescribing cascades showed a dose-dependent relationship. All ACEI-related cascades demonstrated increasing aSRs with higher doses. For example, for ACEI potentially causing cough, followed by various medications in four cascades, aSRs increased from 0.86-2.09 for low doses to 1.29-2.75 for high doses. Dose-dependent relationships were also found for statins, antidepressants, and dihydropyridine calcium channel blockers. No such relationship was observed for cascades involving proton pump inhibitors, diuretics, and non-steroidal anti-inflammatory drugs. Conclusion: Medication dose can play a significant role in prescribing cascades. Clinicians should be aware of potential ADRs at higher doses and consider dose reduction as a strategy to prevent or reverse certain cascades. Supplementary Material File (doserespons 4-5-2025.docx) Download 335.72 KB Information & Authors Information Version history V1 Version 1 05 May 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords adverse drug reactions clinical pharmacology epidemiology pharmacoepidemiology pharmacovigilance pharmacy prescribing Authors Affiliations Ruveyda Gündogan-Yilmaz 0009-0008-5054-4504 OLVG View all articles by this author Sadaf Wahedi OLVG View all articles by this author J.H.M. Driessen Maastricht University Medical Centre+ View all articles by this author Atiya Mohammed OLVG View all articles by this author Petra Denig 0000-0002-7929-4739 University Medical Centre Groningen Department of Clinical Pharmacy and Pharmacology View all articles by this author Fatma Karapinar-Çarkit [email protected] OLVG View all articles by this author Metrics & Citations Metrics Article Usage 343 views 200 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Ruveyda Gündogan-Yilmaz, Sadaf Wahedi, J.H.M. Driessen, et al. Dose-dependent relationships observed for prescribing cascades: a cohort study. Authorea . 05 May 2025. DOI: https://doi.org/10.22541/au.174643575.50252167/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. 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