Search for a command to run...
<h3>Background and Importance</h3> Prescribing cascades occur when an adverse drug reaction (ADR) of a first medication (index medication) is treated with a second medication (marker medication). They can result in polypharmacy and harm. While various interventions are recommended in literature to prevent harm, it is unknown which are implemented in daily practice. <h3>Aim and Objectives</h3> Therefore, the aim of this study was to assess the type of interventions implemented for ADRs. <h3>Material and Methods</h3> This descriptive, cross-sectional study analysed secondary data from spontaneous ADR reports submitted to the Netherlands Pharmacovigilance Centre Lareb between 2019 and 2025. ADR reports were included if the ADR was suspected to be caused by an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) and if an intervention was documented. The primary outcome was the frequency of reported ADRs treated with 1) dose reduction of the index medication, 2) discontinuation of the index medication, 3) discontinuation of the index medication followed by medication to treat the ADR, 4) a switch of index medication, or 5) addition of a marker medication. The secondary outcome was the proportion of ADRs resolved at the time of the ADR report. <h3>Results</h3> A total of 902 spontaneous ADR reports were included. The most frequent interventions were discontinuation of the index medication followed by introducing additional medication to treat the ADR (42.5%) and discontinuation of the index medication only (20.6%). These interventions resulted in the largest proportions of resolved ADRs (46.5% and 50.0%, respectively). However, a considerable number of spontaneous reports included prescribing cascades (11.9%). This was the least effective strategy, resolving ADRs in only 25.2% of cases. <h3>Conclusion and Relevance</h3> Using real-world pharmacovigilance data, this study offers a valuable insight into the treatment of ADRs, caused by ACE inhibitors and ARBs, in daily practice. Further research is needed to establish the most effective interventions for specific types of ADRs. <h3>Conflict of Interest</h3> No conflict of interest