Considering adverse drug reactions when patients present with new symptoms is key to identifying and reducing medication-related harm, according to new Irish research.

Researchers at UCC analysed national prescription data from 533,464 Irish adults aged 65 and over, covering prescriptions dispensed from 2017 to 2020. They used prescription sequence analysis to examine nine expert-defined prescribing cascades, known as ‘ThinkCascades’.

Five cascades showed positive associations, meaning patients were more likely to receive the first medicine before the second:

• Calcium channel blocker to a diuretic
• Alpha-1-receptor blocker to a vestibular sedative
• SSRI or SNRI followed by a sleep agent
• Benzodiazepine to an antipsychotic
• Antipsychotic to an antiparkinsonian agent.

Three drug pairs showed significant negative associations, meaning the first medicine was less likely to be given before the second:

• Diuretic to overactive bladder medication
• Benzodiazepine to an antidementia agent
• NSAID followed by an antihypertensive.

The study was published in The Annals of Family Medicine.