Decision-Making and Downstream Outcomes of the Gabapentinoid-Diuretic Prescribing Cascade

What are the key clinician decision-making steps in the gabapentinoid (gabapentin and pregabalin)–edema–loop diuretic (LD) prescribing cascade and its downstream outcomes?In this cohort study of 120 veterans aged 66 years or older who potentially experienced the gabapentinoid-LD prescribing cascade, clinicians almost never documented consideration of gabapentinoid adverse drug effects in their management of edema. Potential downstream harms, including worsening kidney function, electrolyte abnormalities, and falls (some precipitating emergency department visits and/or hospitalizations) were common among patients initiating both a gabapentinoid and an LD.These findings suggest that prescribing cascades may propagate unintentionally and potentiate important drug-related harms among older adults.

Corresponding Author: Matthew E. Growdon, MD, MPH, Division of Geriatrics, University of California, San Francisco, 490 Illinois St, Floor 8, San Francisco, CA 94158 (matthew.growdon@ucsf.edu).

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