{"id":13979,"date":"2025-07-24T10:40:27","date_gmt":"2025-07-24T08:40:27","guid":{"rendered":"https:\/\/ivrt.de\/?p=13979"},"modified":"2026-02-06T17:07:28","modified_gmt":"2026-02-06T16:07:28","slug":"prescribing-cascades-bei-aelteren-menschen-wenn-eine-nebenwirkung-zur-naechsten-verordnung-fuehrt","status":"publish","type":"post","link":"https:\/\/ivrt.de\/en\/studien-evidenz\/prescribing-cascades-bei-aelteren-menschen-wenn-eine-nebenwirkung-zur-naechsten-verordnung-fuehrt\/","title":{"rendered":"Prescription cascade in older adults: when one side effect leads to the next prescription"},"content":{"rendered":"<p><strong>For Healthcare Professionals:<\/strong><\/p>\n\n\n\n<p>A new study from Ireland highlights frequent prescription cascades in older adults \u2013 also with vestibular relevance:<\/p>\n\n\n\n<p>\ud83d\udd17 <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40494622\/\" data-type=\"link\" data-id=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40494622\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Original study<\/strong><\/a><\/p>\n\n\n\n<p><strong>Background<\/strong><\/p>\n\n\n\n<p><strong>Prescription cascades\u00a0<\/strong>occur when a side effect of a drug is misinterpreted as a new medical condition\u2014and then treated with an additional medication. Older adults with multimorbidity and polypharmacy are particularly at risk. This new analysis of Irish prescription data examined 9 such cascades for the first time in more than 530,000 people aged \u226565 years.<\/p>\n\n\n\n<p><strong>Study design<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Source<strong>:<\/strong>\u00a0: National Prescription Database of Ireland (GMS Scheme)<\/li>\n\n\n\n<li>Method: Prescription Sequence Symmetry Analysis<\/li>\n\n\n\n<li>Observation window: 365 days<\/li>\n\n\n\n<li>Population: 533,464 older adults (\u226565 years)<\/li>\n<\/ul>\n\n\n\n<p><strong>The five most common prescription cascades \u2013 clinically explained<\/strong><\/p>\n\n\n\n<p>1. Antihypertensive \u2192 Diuretic<br>Frequency: 2.6% | Risk nearly doubled (aSR 1.93)<\/p>\n\n\n\n<p><strong>Typical case:<br><\/strong>A calcium channel blocker lowers blood pressure but causes peripheral edema. Instead of switching the drug, a diuretic is added.<\/p>\n\n\n\n<p><strong>Consequence:<br><\/strong>\u2192 Electrolyte disturbances, circulatory problems, dizziness.<\/p>\n\n\n\n<p><strong>2. Prostate medication \u2192 Vestibular sedative (for dizziness)<br><\/strong>Frequency: 3.0% | Risk increased by 63% (aSR 1.63)<\/p>\n\n\n\n<p><strong>Typical case:<\/strong><br>An \u03b11-blocker for benign prostatic hyperplasia lowers blood pressure and leads to orthostatic dizziness. Instead of reducing the dose, a vestibular sedative is prescribed\u2014even though no vestibular disorder is present.<\/p>\n\n\n\n<p><strong>Consequence:<\/strong><br>\u2192 Central balance processing is dampened, gait instability increases, fall risk rises.<\/p>\n\n\n\n<p><strong>3. Antidepressant \u2192 Sleeping pill<\/strong><br>Frequency: 2.5% | Risk increased by 54% (aSR 1.54)<\/p>\n\n\n\n<p><strong>Typical case:<\/strong><br>A patient starts an SSRI or SNRI and develops sleep problems. Instead of adjusting therapy, a sleeping pill is added.<\/p>\n\n\n\n<p><strong>Consequence:<\/strong><br>\u2192 Daytime drowsiness, fall risk, risk of dependence.<\/p>\n\n\n\n<p><strong>4. Antipsychotic \u2192 Parkinson\u2019s medication<\/strong><br>Frequency: 0.4% | Risk increased by 20% (aSR 1.20)<\/p>\n\n\n\n<p><strong>Typical case:<\/strong><br>An antipsychotic causes extrapyramidal symptoms (e.g., rigidity, tremor). These are treated with an antiparkinsonian drug.<\/p>\n\n\n\n<p><strong>Consequence:<\/strong><br>\u2192 Burden on the dopaminergic system, new side effects.<\/p>\n\n\n\n<p><strong>5. Tranquilizer \u2192 Antipsychotic<\/strong><br>Frequency: 3.2% | Risk increased by 15% (aSR 1.15)<\/p>\n\n\n\n<p><strong>Typical case:<\/strong><br>A benzodiazepine triggers a paradoxical reaction (restlessness, confusion). This leads to the prescription of a neuroleptic.<\/p>\n\n\n\n<p><strong>Consequence:<\/strong><br>\u2192 Sedation, gait disorders, delirium risk.<\/p>\n\n\n\n<p><strong>Clinical implications<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Dizziness, sleep problems, or confusion should always be critically assessed for possible side effects.<\/li>\n\n\n\n<li>Vestibular sedatives are frequently prescribed for nonspecific dizziness\u2014without <a href=\"https:\/\/ivrt.de\/en\/patientenedukation\/diagnostische-tests-fuer-gleichgewichtsstoerungen-und-schwindelsymptomatik\/\" data-type=\"post\" data-id=\"8955\">vestibular diagnostics<\/a>.<\/li>\n\n\n\n<li>Prescription cascades increase fall risk, reduce quality of life, and promote functional decline.<\/li>\n<\/ul>\n\n\n\n<p><strong>Conclusion<\/strong><\/p>\n\n\n\n<p>Prescription cascades are frequent and clinically relevant\u2014especially in the <a href=\"https:\/\/ivrt.de\/en\/patientenedukation\/presbyvestibulopathie-altersbedingter-schwindel-und-gangunsicherheit\/\" data-type=\"post\" data-id=\"7179\" target=\"_blank\" rel=\"noreferrer noopener\">geriatric context with balance disorders<\/a>. For physiotherapists, physicians, and pharmacists, careful assessment of every new symptom is essential.<\/p>\n\n\n\n<p><strong>\ud83d\udc49 Would you like to learn how to reliably recognize, differentiate, and treat vestibular dizziness?<br>und behandelt?<\/strong><br>Current further education opportunities can be found in the <strong><a href=\"https:\/\/ivrt.de\/en\/fuer-medizinisches-fachpersonal\/fortbildungssuche\/\" data-type=\"link\" data-id=\"https:\/\/ivrt.de\/fuer-medizinisches-fachpersonal\/fortbildungssuche\/\">IVRT Course search<\/a>.<\/strong><\/p>\n\n\n\n<p><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>For Patients \u2013 Easy to Understand<\/strong><\/p>\n\n\n\n<p><strong>The five most common prescription cascades \u2013 simply explained<\/strong><\/p>\n\n\n\n<p>\ud83d\udcc4 <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40494622\/\" data-type=\"link\" data-id=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40421807\/\" target=\"_blank\" rel=\"noreferrer noopener\">Original study<\/a><\/p>\n\n\n\n<p>1.&nbsp;<strong>Blood pressure medication \u2192 Water pill<\/strong><\/p>\n\n\n\n<p>Frequency: 2.6%<\/p>\n\n\n\n<p><strong>What happens?<\/strong><br>A blood pressure drug (calcium channel blocker) can cause swelling in the legs. Instead of adjusting the medication, a water pill (diuretic) is prescribed.<\/p>\n\n\n\n<p><strong>Consequence:<\/strong><br>Mineral imbalance, circulatory problems, dizziness\u2014and higher fall risk.<\/p>\n\n\n\n<p>2.&nbsp;<strong>Prostate medication \u2192 Dizziness drug<\/strong><\/p>\n\n\n\n<p>Frequency: 3.0%<\/p>\n\n\n\n<p><strong>What happens?<\/strong><br>A prostate drug can lower blood pressure\u2014especially when standing up\u2014causing dizziness. Instead of solving the cause, a dizziness drug is prescribed\u2014even though the balance organ is healthy.<\/p>\n\n\n\n<p><strong>Consequence:<\/strong><br>The dizziness drug dampens brain areas that control balance. You feel unsteady\u2014and the fall risk increases.<br>\ud83d\udc49 Important: These dizziness drugs are only for acute emergencies\u2014and never for more than a few days!<\/p>\n\n\n\n<p>3.&nbsp;<strong>Antidepressant \u2192 Sleeping pill<\/strong><\/p>\n\n\n\n<p>Frequency: 2.5%<\/p>\n\n\n\n<p><strong>What happens?<\/strong><br>A new antidepressant causes sleep problems. Instead of adjusting treatment, a sleeping pill is prescribed.<\/p>\n\n\n\n<p><strong>Consequence:<\/strong><br>Daytime fatigue, unsteadiness\u2014or dependence on the sleeping pill.<\/p>\n\n\n\n<p>4.&nbsp;<strong>Medication for psychological symptoms \u2192 Parkinson\u2019s drug<\/strong><\/p>\n\n\n\n<p>Frequency: 0.4%<\/p>\n\n\n\n<p><strong>What happens?<\/strong><br>A drug for hallucinations or severe restlessness can cause muscle stiffness or tremors. Instead of reviewing that medication, a Parkinson\u2019s drug is prescribed.<\/p>\n\n\n\n<p><strong>Consequence:<\/strong><br>More drugs, unnecessary Parkinson\u2019s medication, and new side effects.<\/p>\n\n\n\n<p>5.&nbsp;<strong>Tranquilizer \u2192 Antipsychotic (neuroleptic)<\/strong><\/p>\n\n\n\n<p>Frequency: 3.2%<\/p>\n\n\n\n<p><strong>What happens?<\/strong><br>A tranquilizer (e.g., benzodiazepine) can paradoxically cause restlessness or hallucinations. Another strong drug (neuroleptic) is then prescribed.<\/p>\n\n\n\n<p><strong>Consequence:<\/strong><br>Fatigue, unsteadiness, concentration issues.<\/p>\n\n\n\n<p><strong>What you can do<\/strong><\/p>\n\n\n\n<p><strong>Talk openly about your complaints.<\/strong><br>If you notice new symptoms, consult your doctor.<br>Ask directly: \u201cCould this be a side effect of my medication?\u201d<\/p>\n\n\n\n<p><strong>Get a second opinion<\/strong><br>\u2014 for example, from your pharmacist.<\/p>\n\n\n\n<p><strong>In case of dizziness or balance problems:<\/strong><br>If your complaints are not caused by medication, a vestibular disorder may be the underlying reason.<\/p>\n\n\n\n<p>\ud83c\udfaf Our certified&nbsp;<strong>IVRT\u00ae dizziness and vestibular therapists<\/strong>&nbsp;can provide individual support: <strong><a href=\"https:\/\/ivrt.de\/en\/fuer-betroffene\/therapeutensuche\/\" target=\"_blank\" rel=\"noreferrer noopener\">IVRT therapist search<\/a><\/strong><\/p>\n\n\n\n<p><a id=\"_msocom_1\"><\/a><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>","protected":false},"excerpt":{"rendered":"<p>F\u00fcr Fachpersonal: Eine neue Studie aus Irland zeigt h\u00e4ufige medikament\u00f6se Kaskaden im Alter \u2013 auch mit vestibul\u00e4rer Relevanz: \ud83d\udd17 Originalstudie auf PubMed Hintergrund Verordnungskaskaden\u00a0entstehen, wenn eine Nebenwirkung eines Medikaments als neue Erkrankung fehlinterpretiert wird \u2013 und dann mit einem weiteren Medikament behandelt wird. Besonders gef\u00e4hrdet sind \u00e4ltere Menschen mit Multimorbidit\u00e4t und Polypharmazie. Die neue Analyse [&hellip;]<\/p>\n","protected":false},"author":11,"featured_media":13980,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_surecart_dashboard_logo_width":"180px","_surecart_dashboard_show_logo":true,"_surecart_dashboard_navigation_orders":true,"_surecart_dashboard_navigation_invoices":true,"_surecart_dashboard_navigation_subscriptions":true,"_surecart_dashboard_navigation_downloads":true,"_surecart_dashboard_navigation_billing":true,"_surecart_dashboard_navigation_account":true,"_jf_save_progress":"","iawp_total_views":122,"footnotes":""},"categories":[215],"tags":[],"class_list":["post-13979","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-studien-evidenz"],"_links":{"self":[{"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/posts\/13979","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/comments?post=13979"}],"version-history":[{"count":1,"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/posts\/13979\/revisions"}],"predecessor-version":[{"id":17490,"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/posts\/13979\/revisions\/17490"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/media\/13980"}],"wp:attachment":[{"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/media?parent=13979"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/categories?post=13979"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ivrt.de\/en\/wp-json\/wp\/v2\/tags?post=13979"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}