Prescription cascades associated with acetylcholinesterase inhibitors use: a high-throughput sequence symmetry analysis.
Background Acetylcholinesterase inhibitors (AChEIs), are commonly prescribed for dementia and can cause adverse drug events that may lead to new prescriptions, known as prescription cascades. We aimed to identify potential AChEI-induced prescription cascades using high-throughput sequence symmetry a...
| Publicado en: | Age & Ageing Vol. 55; no. 6; pp. 1 - 11 |
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| Autores principales: | , , , , , , , , , |
| Formato: | Artículo |
| Publicado: |
Oxford University Press / USA
Jun2026
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=195099736&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 195099736 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Jun2026 vid: 55 iid: 6 pid: 622 pub: Oxford University Press / USA artinfo: ui: 195099736 10.1093/ageing/afag188 ppf: 1 ppct: 10 formats: tig: atl: Prescription cascades associated with acetylcholinesterase inhibitors use: a high-throughput sequence symmetry analysis. aug: au: Newby, Danielle Bobba, Sai Sumedha Raventós, Berta Rowlands, Elin J Chen, Xihang Molina-Porcel, Laura Reyes, Carlen Duarte-Salles, Talita Delmestri, Antonella Man, Wai Yi affil: Health Data Sciences (HDS), Translational Sciences, Botnar Research Centre, University of Oxford, Oxford, UK Health System, University of Alabama at Birmingham Birmingham, Alabama 35294, USA IDIAP Jordi Gol, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, SpainErasmus MC Universitair Medisch Centrum Rotterdam, Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, ZH, The Netherlands Biobanc de l'Hospital Clinic IDIBAPS, Neurological Tissue Bank of the Biobanc-Hospital Clinic-Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, SpainIDIBAPS–Alzheimer's disease and other cognitive disorders unit, Neurology Service, Hospital Clínic, Barcelona, Spain Sardenya Primary Health Care Center, Equip d'Atenció Primària Barcelona Sardenya research unit- Sant Pau Research Institute (EAP Sarden), Barcelona, Spain IDIAP Jordi Gol, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, SpainDepartment of Medical Informatics, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands su: United Kingdom Drug side effects Primary health care Drugs Benzodiazepines Donepezil Rivastigmine Risk assessment Pharmacology Drug allergy Diarrhea Adrenocortical hormones Steroids Cholinesterase inhibitors Research funding Piperidine Polypharmacy Descriptive statistics Tranquilizing drugs Respiratory diseases Deprescribing Neurological disorders Rhinorrhea Drug interactions Electronic health records Physician practice patterns Galanthamine Data analysis software Confidence intervals Drug eruptions Drug prescribing Sequence analysis Sensitivity & specificity (Statistics) Nausea Gastrointestinal diseases sug: subj: Drug side effects Primary health care Drugs United Kingdom Pharmaceuticals and pharmacy supplies merchant wholesalers Pharmaceutical and medicine manufacturing Drugs and Druggists' Sundries Merchant Wholesalers Medicinal and Botanical Manufacturing Benzodiazepines Donepezil Rivastigmine Risk assessment Pharmacology Drug allergy Diarrhea Adrenocortical hormones Steroids Cholinesterase inhibitors Research funding Piperidine Polypharmacy Descriptive statistics Tranquilizing drugs Respiratory diseases Deprescribing Neurological disorders Rhinorrhea Drug interactions Electronic health records Physician practice patterns Galanthamine Data analysis software Confidence intervals Drug eruptions Drug prescribing Sequence analysis Sensitivity & specificity (Statistics) Nausea Gastrointestinal diseases keyword: acetylcholinesterase inhibitors adverse drug events adverse effects of medication aged copyrightHolder:British Geriatrics Society copyrightYear:2026 dementia donepezil galantamine gastrointestinal agents glucocorticoids https://dx.doi.org/10.1093/ageing/afag188 inLanguage:en nervous system older people pharmacovigilance prescription cascade publisher:Oxford University Press rivastigmine sameAs:https://pubmed.ncbi.nlm.nih.gov/42341204/ sensitivity analysis sequence symmetry analysis signal detection (psychology) united states social security administration acetylcholinesterase inhibitors adverse drug events adverse effects of medication aged copyrightHolder:British Geriatrics Society copyrightYear:2026 dementia donepezil galantamine gastrointestinal agents glucocorticoids https://dx.doi.org/10.1093/ageing/afag188 inLanguage:en nervous system older people pharmacovigilance prescription cascade publisher:Oxford University Press rivastigmine sameAs:https://pubmed.ncbi.nlm.nih.gov/42341204/ sensitivity analysis sequence symmetry analysis signal detection (psychology) united states social security administration ab: Background Acetylcholinesterase inhibitors (AChEIs), are commonly prescribed for dementia and can cause adverse drug events that may lead to new prescriptions, known as prescription cascades. We aimed to identify potential AChEI-induced prescription cascades using high-throughput sequence symmetry analysis (SSA). Methods Patients aged ≥18 years with 365 days of prior observation initiating AChEIs (donepezil, rivastigmine, or galantamine) were identified from the Clinical Practice Research Datalink GOLD (2002–2022). We screened 510 drug classes and 1213 individual ingredients initiated within ±180 days of AChEI initiation (365 days in sensitivity analyses). Crude and adjusted sequence ratios (ASRs) were calculated, and positive signals were reviewed for clinical plausibility. Results We identified 66 155 AChEI initiators (median age 81 years [IQR 76–85]; 62.8% female). Among ATC classes and individual ingredients, 51 and 46 signals were positive with 28 (55%) and 22 (48%) classified as potential prescription cascades after review. Gastrointestinal drugs showed positive signals including antipropulsives (ASR 1.50 [99% CI 1.28–1.75]), loperamide (ASR 1.52 [1.30–1.77]) and cyclizine (ASR 2.10 [1.72–2.59]). Positive signals were also observed nervous system drugs such as benzodiazepine derivatives (ASR 1.83 [1.55–2.16]) and respiratory drugs including corticosteroids (ASR 1.66 [1.33–2.08]) and glucocorticoids (ASR 1.54 [1.30–1.83]). Most positive signals remained in sensitivity analysis. Conclusions These findings suggest potential AChEI-related prescription cascades consistent with gastrointestinal, neuropsychiatric, dermatological and respiratory adverse effects. While findings require further validation, this study demonstrates the utility of high-throughput signal detection to support pharmacovigilance in high-risk populations. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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