What question did this study set out to answer?

The research aims to investigate whether adverse drug reactions from antihypertensives and NSAIDs contribute to initiating prochlorperazine prescriptions.

March 24, 2026Open Access

Investigating Potential Prescribing Cascades Resulting in Prochlorperazine Prescription: An Exploratory Analysis of Antihypertensives and NSAIDs

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Potential prescribing cascades (adverse drug reactions to antihypertensives or NSAIDs) (n=514056). Intervention: Antihypertensives or NSAIDs vs. Reverse sequence (prochlorperazine initiated before antihypertensives or NSAIDs). Primary outcome: Subsequent prochlorperazine prescription (adjusted sequence ratio) (aSR 1.27-1.81, 95% CI 1.16-2.19).

Resultado clave

Initiation of NSAIDs or antihypertensives significantly increased the likelihood of subsequent prochlorperazine prescription, with adjusted sequence ratios ranging from 1.27 to 1.81.

Puntos clave

The research aims to investigate whether adverse drug reactions from antihypertensives and NSAIDs contribute to initiating prochlorperazine prescriptions.
Exploratory analysis of prescribing patterns associated with NSAIDs and antihypertensives
Focus on older adults experiencing adverse drug reactions
Data review includes clinical indications for prescriptions
Identified prochlorperazine initiation linked to antihypertensive and NSAID use
Noted adverse drug reactions like nausea and dizziness might drive prescribing decisions
Emphasized the need for further research to clarify prescribing patterns

Diseño del estudio

Tipo

Observational (n=514,056)

PICO estructurado

Does the initiation of antihypertensives or NSAIDs increase the risk of subsequent prochlorperazine prescription in older adults?

Población

Community-dwelling Irish adults aged ≥ 65 years who were incident users of antihypertensives or NSAIDs and prochlorperazine

Intervención

Initiation of antihypertensives (alpha adrenoreceptor blockers, beta blockers, calcium channel blockers, diuretics, angiotensin receptor blockers, angiotensin-converting enzyme inhibitors) or NSAIDs

Comparador

Reverse sequence (prochlorperazine initiated before antihypertensive or NSAID)

Resultado

Subsequent prescription of prochlorperazine (potential prescribing cascade)safety

Initiation of antihypertensives or NSAIDs in older adults is associated with a significantly increased risk of subsequent prochlorperazine prescription, highlighting a potential prescribing cascade driven by unrecognized adverse drug reactions.

Resultado numérico

Estimación del efecto: aSR 1.27-1.81 (95% CI 1.16-2.19)

Limitaciones

Causation cannot be interpreted from the observational PSSA design
Prochlorperazine may have been prescribed for other clinical indications rather than an adverse drug reaction
Small sample sizes for some individual medication dyads resulted in wider confidence intervals
Over-the-counter and non-GMS dispensed prescriptions were not included
Lack of diagnostic/morbidity data prevented exclusion of participants with prior clinical indications for prochlorperazine

Resumen

NSAID and antihypertensive-induced ADRs such as dizziness or nausea may contribute to subsequent prochlorperazine initiation among adults who are older, representing a potential prescribing cascade. Further research examining data that include clinical indications for prescribing is needed to confirm whether these signals represent true prescribing cascades or prescribing for another reason. ADRs should be included in the differential diagnosis for people who are older presenting with new symptoms in primary care.

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Cite This Study

Gilmore et al. (Sat,) conducted a observational in Potential prescribing cascades (adverse drug reactions to antihypertensives or NSAIDs) (n=514,056). Antihypertensives or NSAIDs vs. Reverse sequence (prochlorperazine initiated before antihypertensives or NSAIDs) was evaluated on Subsequent prochlorperazine prescription (adjusted sequence ratio) (aSR 1.27-1.81, 95% CI 1.16-2.19). Initiation of NSAIDs or antihypertensives significantly increased the likelihood of subsequent prochlorperazine prescription, with adjusted sequence ratios ranging from 1.27 to 1.81.

synapsesocial.com/papers/69c2294caeb5a845df0d3877 https://doi.org/https://doi.org/10.1007/s40266-026-01293-x

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