{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T18:18:01Z","timestamp":1784312281799,"version":"3.55.0"},"reference-count":16,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Geriatrics"],"abstract":"<jats:p>The aging of the population and the increasing prevalence of multimorbidity contribute to the widespread use of polypharmacotherapy, which in turn elevates the risk of adverse drug reactions and clinically significant drug\u2013drug interactions. One of the key yet frequently underestimated issues in clinical practice is the prescribing cascade, which occurs when an adverse drug reaction is misinterpreted as a new medical condition, leading to the initiation of an additional medication. This phenomenon is particularly relevant in the older population, in whom altered pharmacokinetics and pharmacodynamics, together with reduced organ reserve, increase susceptibility to adverse drug events, including nephrotoxicity (renal impairment is used throughout the review as a clinically relevant example of organ-specific harm resulting from prescribing cascades, rather than as the sole focus of the analysis). This article discusses the mechanisms and clinical consequences of the prescribing cascade\u2014with particular emphasis on renal function deterioration\u2014as well as strategies for its prevention in the geriatric population. Analysis of the literature indicates that prescribing cascades remain insufficiently recognized in clinical practice, despite the availability of pharmacotherapy assessment tools such as The American Geriatrics Society (AGS) Beers Criteria and the STOPP\/START criteria. Documented prescribing cascades have been shown to contribute to deterioration in health status and quality of life, an increased frequency of hospitalizations, and a greater burden on healthcare systems. Particularly concerning are cascades involving cardiovascular, neurological, and analgesic medications, which may induce or exacerbate renal injury, ultimately leading to chronic kidney disease and organ failure. Prescribing cascades represent a significant yet frequently underestimated threat to the efficacy and safety of pharmacotherapy in older adults. Their consequences may extend beyond reduced quality of life and increased treatment costs to include serious complications such as the development of renal failure. Enhancing clinicians\u2019 awareness, conducting systematic medication reviews, and employing validated assessment tools are essential for the identification and prevention of prescribing cascades, thereby reducing the risk of renal injury and improving clinical outcomes.<\/jats:p>","DOI":"10.3390\/geriatrics11020037","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T08:09:18Z","timestamp":1774944558000},"page":"37","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prescribing Cascade as a Therapeutic Error: A Danger for Geriatric Patients with Multimorbidity"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6795-2052","authenticated-orcid":false,"given":"Adrian","family":"Bry\u0142a","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacology, Chair of Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, Grzegorzecka 16, 31-531 Krakow, Poland"},{"name":"Clinical Pharmacy Team, Ludwik Rydygier Specialist Hospital, Os. Zlotej Jesieni 1, 31-826 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3688-1877","authenticated-orcid":false,"given":"Jaros\u0142aw","family":"Woro\u0144","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Chair of Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, Grzegorzecka 16, 31-531 Krakow, Poland"},{"name":"Clinical Department of Anesthesiology and Intensive Care and Clinical Pharmacology Consulting Office, University Hospital in Krakow, Macieja Jakubowskiego 2, 30-688 Krakow, Poland"},{"name":"University Center for Monitoring and Research on Adverse Drug Reactions, Sniadeckich 10, 31-531 Krakow, Poland"},{"name":"Pharma Consult, Pharmacotherapy Safety Team, Oberconiowka 30\/8, 34-500 Zakopane, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9773-1461","authenticated-orcid":false,"given":"Mi\u0142osz","family":"Miedziaszczyk","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, Fredry 26\/28, 61-927 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2238-8205","authenticated-orcid":false,"given":"Barbara","family":"Lorkowska-Zawicka","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Chair of Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, Grzegorzecka 16, 31-531 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8960-514X","authenticated-orcid":false,"given":"Beata","family":"Bujak-Gi\u017cycka","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Chair of Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, Grzegorzecka 16, 31-531 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4958-6909","authenticated-orcid":false,"given":"Daniel","family":"Orzechowski","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Team, Ludwik Rydygier Specialist Hospital, Os. Zlotej Jesieni 1, 31-826 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulina","family":"Po\u0142etek","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Team, Ludwik Rydygier Specialist Hospital, Os. Zlotej Jesieni 1, 31-826 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Pa\u0142ys","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, SPZOZ Hospital in Brzoz\u00f3w, Bielawskiego 18, 36-200 Brzozow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1007\/s40266-023-01072-y","article-title":"Prescribing Cascades with recommendations to Prevent or Reverse Them: A Systematic Review","volume":"40","author":"Adrien","year":"2023","journal-title":"Drugs Aging"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1001\/jamainternmed.2019.7087","article-title":"Evaluation of a Common Prescribing Cascade of Calcium Channel Blockers and Diuretics in Older Adults with Hypertension","volume":"180","author":"Savage","year":"2020","journal-title":"JAMA Intern. Med."},{"key":"ref_3","first-page":"42","article-title":"Farmakoterapia nieprawid\u0142owo dobrana, co to znaczy w praktyce, a tak\u017ce w Oddziale Intensywnej Terapii","volume":"17","author":"Drygalski","year":"2023","journal-title":"Anaesthesiol. Rescue Med.\/Anestezjol. Ratow."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1016\/S0140-6736(17)31188-1","article-title":"The prescribing cascade revisited","volume":"6","author":"Rochon","year":"2017","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e01008","DOI":"10.1002\/prp2.1008","article-title":"Prescribing cascades in community-dwelling adults: A systematic review","volume":"10","author":"Doherty","year":"2022","journal-title":"Pharmacol. Res. Perspect."},{"key":"ref_6","first-page":"745","article-title":"Prescribing Cascades: How to Detect Them, Prevent Them, and Use Them Appropriately","volume":"119","author":"Dreischulte","year":"2022","journal-title":"Dtsch. \u00c4rzteblatt Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1007\/s40266-022-00964-9","article-title":"A Tool for Identifying Clinically Important Prescribing Cascades Affecting Older People","volume":"39","author":"McCarthy","year":"2022","journal-title":"Drugs Aging"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1002\/phar.2880","article-title":"Prescribing cascades in ambulatory care: A structured synthesis of evidence","volume":"44","author":"Shahid","year":"2024","journal-title":"Pharmacotherapy"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Chen, Z., Liu, Z., Zeng, L., Huang, L., and Zhang, L. (2023). Research on prescribing cascades: A scoping review. Front. Pharmacol., 14.","DOI":"10.3389\/fphar.2023.1147921"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"afae116","DOI":"10.1093\/ageing\/afae116","article-title":"Stakeholder perceptions of and attitudes towards problematic polypharmacy and prescribing cascades: A qualitative study","volume":"53","author":"Jennings","year":"2024","journal-title":"Age Ageing"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"afac138","DOI":"10.1093\/ageing\/afac138","article-title":"Prescribing cascades: We see only what we look for, we look for only what we know","volume":"51","author":"Rochon","year":"2022","journal-title":"Age Ageing"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1007\/s41999-025-01215-x","article-title":"International expert panel\u2019s potentially inappropriate prescribing cascades (PIPC) list","volume":"16","author":"Rochon","year":"2025","journal-title":"Eur. Geriatr. Med."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"American Geriatrics Society Beers Criteria (2023). Update Expert Panel. American Geriatrics Society 2023. Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J. Am. Geriatr. Soc., 71, 923\u2013947.","DOI":"10.1111\/jgs.18372"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Farrell, B., Tsang, C., Raman-Wilms, L., Irving, H., Conklin, J., and Pottie, K. (2015). What are priorities for deprescribing for elderly patients? Capturing the voice of practitioners: A modified Delphi process. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0122246"},{"key":"ref_15","first-page":"13","article-title":"Prescribing cascade. A proposed new way to evaluate it","volume":"77","author":"Ponte","year":"2017","journal-title":"Medicina"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1111\/jgs.15800","article-title":"Assessing the Scope and Appropriateness of Prescribing Cascades","volume":"67","author":"McCarthy","year":"2019","journal-title":"J. Am. Geriatr. Soc."}],"container-title":["Geriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3417\/11\/2\/37\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T08:36:12Z","timestamp":1774946172000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3417\/11\/2\/37"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":16,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["geriatrics11020037"],"URL":"https:\/\/doi.org\/10.3390\/geriatrics11020037","relation":{},"ISSN":["2308-3417"],"issn-type":[{"value":"2308-3417","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]}}}