Identifying Prescribing Cascades in Alzheimer's Disease and Related Dementias: The Calcium Channel Blocker-Diuretic Prescribing Cascade

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    Sunday, March 14, 2021

    Prescribing cascades occur when a physician prescribes a new drug to address the side-effect of another drug. Persons with Alzheimer's disease and related dementias (ADRD) are at increased risk for prescribing cascades. Our objective was to develop an approach to estimating the proportion of calcium channel blocker-diuretic (CCB-diuretic) prescribing cascades among persons with ADRD in two U.S. health plans. We identified patients aged ≥50 on January 1, 2017, dispensed a drug to treat ADRD in the 365-days prior to/on cohort entry date. Patients had medical/pharmacy coverage for one year before and through cohort entry. We excluded individuals with an institutional stay encounter in the 45 days prior to cohort entry and censored patients based on: disenrollment from coverage, death, or end of data. We identified incident and prevalent CCB use in the 183-days following cohort entry, and identified subsequent incident diuretic use among incident and prevalent CCB-users within 365-days from cohort entry.


    Sonal Singh, Noelle M. Cocoros, Kevin Haynes, Vinit P. Nair, Thomas P. Harkins, Paula A. Rochon, Richard Platt, Inna Dashevsky, Juliane Reynolds, Kathleen M. Mazor, Sarah Bloomstone, Kathryn Anzuoni, Sybil L. Crawford, Jerry H. Gurwitz