Prescribing Cascades: An Umbrella Review and Updated Systematic Review

Nicholson K, Liu W, Fitzpatrick D, et al. Prevalence of multimorbidity and polypharmacy among adults and older adults: a systematic review. Lancet Healthy Longev. 2024;5(4):e287–96. https://doi.org/10.1016/S2666-7568(24)00007-2.

Article  PubMed  Google Scholar 

Formica D, Sultana J, Cutroneo PM, et al. The economic burden of preventable adverse drug reactions: a systematic review of observational studies. Expert Opin Drug Saf. 2018;17(7):681–95. https://doi.org/10.1080/14740338.2018.1491547.

Article  CAS  PubMed  Google Scholar 

Carollo M, Boccardi V, Crisafulli S, et al. Medication review and deprescribing in different healthcare settings: a position statement from an Italian scientific consortium. Aging Clin Exp Res. 2024;36(1):63. https://doi.org/10.1007/s40520-023-02679-2.

Article  PubMed  PubMed Central  Google Scholar 

Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ. 1997;315(7115):1096–9. https://doi.org/10.1136/bmj.315.7115.1096.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Dalton K, Evrard P, Moriarty F, et al. How are prescribing cascades defined in the literature? A scoping review. Res Social Adm Pharm. 2025. https://doi.org/10.1016/j.sapharm.2025.07.001.

Article  PubMed  Google Scholar 

McCarthy LM, Visentin JD, Rochon PA. Assessing the scope and appropriateness of prescribing cascades. J Am Geriatr Soc. 2019;67(5):1023–6. https://doi.org/10.1111/jgs.15800.

Article  PubMed  Google Scholar 

Hallyburton A. Diagnostic overshadowing: an evolutionary concept analysis on the misattribution of physical symptoms to pre-existing psychological illnesses. Int J Ment Health Nurs. 2022;31(6):1360–72. https://doi.org/10.1111/inm.13034.

Article  PubMed  PubMed Central  Google Scholar 

Trifirò G, Spina E. Age-related changes in pharmacodynamics: focus on drugs acting on central nervous and cardiovascular systems. Curr Drug Metab. 2011;12(7):611–20. https://doi.org/10.2174/138920011796504473.

Article  PubMed  Google Scholar 

Rochon PA, Li J, O’Mahony D, et al. The impact of age, sex, and gender on polypharmacy and potential prescribing cascades: lessons from five databases. J Am Geriatr Soc. 2025;73(2):520–32. https://doi.org/10.1111/jgs.19282.

Article  PubMed  Google Scholar 

Doherty AS, Shahid F, Moriarty F, et al. Prescribing cascades in community-dwelling adults: a systematic review. Pharmacol Res Perspect. 2022;10(5):e01008. https://doi.org/10.1002/prp2.1008.

Article  PubMed  PubMed Central  Google Scholar 

Daunt R, McGettigan S, Kelly L, Curtin D, O’Mahony D. Detection of potential prescribing cascades in multimorbid older patients hospitalised with acute illness—an observational prospective prevalence study. Drugs Aging. 2025;42(6):535–46. https://doi.org/10.1007/s40266-025-01201-9.

Article  PubMed  PubMed Central  Google Scholar 

Gates M, Gates A, Pieper D, et al. Reporting guideline for overviews of reviews of healthcare interventions: development of the PRIOR statement. BMJ. 2022. https://doi.org/10.1136/bmj-2022-070849.

Article  PubMed  PubMed Central  Google Scholar 

Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7:10. https://doi.org/10.1186/1471-2288-7-10.

Article  PubMed  PubMed Central  Google Scholar 

Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008. https://doi.org/10.1136/bmj.j4008.

Article  PubMed  PubMed Central  Google Scholar 

JBI critical appraisal tools | JBI. https://jbi.global/critical-appraisal-tools. Accessed 4 Sept 2025.

Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc. 2015;13(3):132–40. https://doi.org/10.1097/XEB.0000000000000055.

Article  PubMed  Google Scholar 

Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. Umbrella reviews (2020). Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis. 9. Umbrella reviews. https://jbi-global-wiki.refined.site/space/MANUAL/355829653/9.+Umbrella+reviews. Accessed 1 Apr 2025.

Morris EJ, Hollmann J, Hofer AK, et al. Evaluating the use of prescription sequence symmetry analysis as a pharmacovigilance tool: a scoping review. Res Soc Adm Pharm. 2022;18(7):3079–93. https://doi.org/10.1016/j.sapharm.2021.08.003.

Article  Google Scholar 

Chen Z, Liu Z, Zeng L, Huang L, Zhang L. Research on prescribing cascades: a scoping review. Front Pharmacol. 2023;14:1147921. https://doi.org/10.3389/fphar.2023.1147921.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Adrien O, Mohammad AK, Hugtenburg JG, et al. Prescribing cascades with recommendations to prevent or reverse them: a systematic review. Drugs Aging. 2023;40(12):1085–100. https://doi.org/10.1007/s40266-023-01072-y.

Article  PubMed  PubMed Central  Google Scholar 

Doherty A, Moriarty F, Boland F, et al. Prescribing cascades in community-dwelling adults: protocol for a systematic review. HRB Open Res. 2021;4:72. https://doi.org/10.12688/hrbopenres.13345.2.

Article  PubMed  PubMed Central  Google Scholar 

Shahid F, Doherty A, Wallace E, Schmiedl S, Alexander GC, Dreischulte T. Prescribing cascades in ambulatory care: a structured synthesis of evidence. Pharmacotherapy. 2024;44(1):87–96. https://doi.org/10.1002/phar.2880.

Article  PubMed  Google Scholar 

Clifford GM, Farmer RDT. Drug or symptom-induced depression in men treated with alpha 1-blockers for benign prostatic hyperplasia? A nested case–control study. Pharmacoepidemiol Drug Saf. 2002;11(1):55–61. https://doi.org/10.1002/pds.671.

Article  CAS  PubMed  Google Scholar 

Dyson TE, Cantrell MA, Lund BC. Lack of association between 5α-reductase inhibitors and depression. J Urol. 2020;204(4):793–8. https://doi.org/10.1097/JU.0000000000001079.

Article  PubMed  Google Scholar 

Fox CW, Khaw CL, Gerke AK, Lund BC. Montelukast and neuropsychiatric events—a sequence symmetry analysis. J Asthma. 2022;59(12):2360–6. https://doi.org/10.1080/02770903.2021.2018705.

Article  PubMed  Google Scholar 

Hagberg KW, Divan HA, Nickel JC, Jick SS. Risk of incident antidepressant-treated depression associated with use of 5α-reductase inhibitors compared with use of α-blockers in men with benign prostatic hyperplasia: a population-based study using the Clinical Practice Research Datalink. Pharmacotherapy. 2017;37(5):517–27. https://doi.org/10.1002/phar.1925.

Article  CAS  PubMed  Google Scholar 

Hersom K, Neary MP, Levaux HP, Klaskala W, Strauss JS. Isotretinoin and antidepressant pharmacotherapy: a prescription sequence symmetry analysis. J Am Acad Dermatol. 2003;49(3):424–32. https://doi.org/10.1067/s0190-9622(03)02087-5.

Article  PubMed  Google Scholar 

Hoang T, Liu J, Roughead E, Pratt N, Li J. Supervised signal detection for adverse drug reactions in medication dispensing data. Comput Methods Programs Biomed. 2018;161:25–38. https://doi.org/10.1016/j.cmpb.2018.03.021.

Article  PubMed  Google Scholar 

Idema D, Wang Y, Biehl M, Horvatovich P, Hak E. Effect estimate comparison between the prescription sequence symmetry analysis (PSSA) and parallel group study designs: a systematic review. PLoS ONE. 2025. https://doi.org/10.1371/journal.pone.0208389.

Article  PubMed  PubMed Central  Google Scholar 

Kröger E, Van Marum R, Souverein P, Carmichael PH, Egberts T. Treatment with rivastigmine or galantamine and risk of urinary incontinence: results from a Dutch database study. Pharmacoepidemiol Drug Saf. 2015;24(3):276–85. https://doi.org/10.1002/pds.3741.

Article  PubMed  Google Scholar 

Lai ECC, Hsieh CY, Wong MB, et al. Comparative risk of oral ulcerations among antipsychotics users—population-based retrospective cohort study. Pharmacoepidemiol Drug Saf. 2016;25(2):123–32. https://doi.org/10.1002/pds.3903.

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