Deprescribing and Multimodal Korean Medicine for Sequential Prescribing Cascades (Dyspepsia, Drug-Induced Parkinsonism, and Hypokalemia) in an Elderly Patient with Polypharmacy: A Case Report

Objectives: Prescribing cascades (PCs) pose severe risks to elderly patients, particularly those receiving fragmented medical care. This report presents a life-threatening case of sequential PCs that was managed using a comprehensive multimodal Korean Medicine (KM) approach.Methods & Results: An 81-year-old female experienced recurrent PCs: polypharmacy-induced dyspepsia, levosulpiride-induced parkinsonism (Hoehn and Yahr stage 3), and steroid/diuretic-induced critical hypokalemia (K⁺ 2.5 mEq/L) presenting with generalized weakness (ECOG grade 2, MRC grade 4). Improvement was observed following a comprehensive, multimodal KM intervention—which prioritized the targeted deprescribing of offending drugs, alongside dietary correction and a modified Cheonmagudeung-eum (Tianma Gouteng Yin; 天麻鉤藤飮) decoction. Within two weeks, serum potassium normalized (3.5 mEq/L), and functional deficits resolved.Conclusions: The resolution of these life-threatening PCs was associated with clinical recovery after targeted deprescribing and multimodal supportive care. This strategy may help to mitigate the harms caused by fragmented geriatric care.