Pill Talk: When new medications bring new problems

There is a concept in medicine known as a "prescribing cascade." A prescribing cascade happens when a new medication is started to treat a symptom that's actually the side effect of another medication. In turn, the new medication can result in additional side effects — and additional prescriptions to treat them. The resulting prescribing cascade can be a particularly challenging issue for older patients who are more likely to have chronic conditions being treated with multiple medications.

Prescribing cascades can occur not only with prescription medications but also with readily available over-the-counter medications. A well-established example of this can happen with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs include ibuprofen (Advil, Motrin) or naproxen (Aleve). NSAIDs can cause an increase in blood pressure that can lead to the initiation or increased doses of blood pressure medications. Another example of this can happen with the prescription medication lisinopril, which is commonly used for high blood pressure. Lisinopril can cause a dry cough in some patients that could potentially lead to use of either over-the-counter or prescription cough suppressants.

So, what can you do? The first important step is to know what side effects to look for with a new medication. Your pharmacist will provide counseling on common side effects when you pick up a new medication, and the paperwork included with your prescription should also include a list of possible side effects. Second, pay attention to timing. Most often side effects will present shortly after starting or increasing the dose of a medication. Finally, before stopping a medication you think may be causing a side effect, or deciding to add an over-the-counter remedy on your own, discuss the issue with your treatment provider.

Lexie Powell is an academic fellow at the Department of Pharmacology at the WSU College of Pharmacy and Pharmaceutical Sciences based in Spokane.

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