Peer-reviewed veterinary case report
What prescribing cascades mean for pet medication safety
By Fernandez-Llimos F & Tonin FS.·2026·Institute for Health and Bioeconomy (i4HB)·View original on Europe PMC →
PetCaseFinder translated the abstract of this peer-reviewed paper into plain English so pet owners can read it. We do not publish original research — every detail traces back to the citation above. How we work →
Original publication title: Informing a medical subject heading (MeSH) request: The 'Prescribing cascades' case study.
Plain-English summary
This study looked at the concept of "prescribing cascades," which happens when new medications are given to treat side effects from other drugs, often leading to confusion about whether these are new health issues. Researchers analyzed 139 articles to see if a specific term for this idea was needed in medical indexing systems. They found that while many articles were indexed under existing terms related to drug side effects and inappropriate prescribing, there wasn't enough evidence to create a new term specifically for prescribing cascades. The conclusion was that current terms are adequate for capturing the important aspects of this issue, but more research is needed to improve how these topics are indexed and understood.
Abstract
<h4>Background</h4>'Prescribing cascades' describes initiation of new treatments in response to adverse drug effects, often misinterpreted as new conditions. Although Medical Subject Headings (MeSH) enable accurate indexing and retrieval, no MeSH term exists for this concept. This study assessed the need for a dedicated MeSH term and its potential impact on indexing consistency.<h4>Methods</h4>A cross-sectional analysis was conducted using 139 articles from a published scoping review. PubMed metadata provided publication details and indexing status. MEDLINE-indexed articles were analyzed for MeSH attribution. Associations between the presence of keywords ("inapprop-", "adverse", "cascade") in titles/abstracts and specific MeSH terms were quantified using odds ratios (OR) with 95% confidence intervals (CI) (R/RStudio).<h4>Results</h4>Of 139 articles included in the scoping review, 119 were indexed in PubMed and 106 in MEDLINE, with 1055 MeSH terms covering 313 unique terms. The most prevalent were "Drug-Related Side Effects and Adverse Reactions" (32.1%), "Polypharmacy" (30.2%), and "Inappropriate Prescribing" (26.4%). Indexing was manual in 47 cases, automated in 45, and curated in 14. After 2022, automated indexing reduced use of "Drug Interactions" and "Medication Errors." Only three associations demonstrated predictive values: the root "inapprop-" in abstracts predicted the MeSH "Inappropriate Prescribing" (OR = 5.1 [95% CI 1.9-13.7]); "inapprop-" in titles for "Potentially Inappropriate Medication List" (OR = 204 [95% CI 9.1-4551.3]); and "adverse" in abstracts for "Drug-Related Side Effects and Adverse Reactions" (OR = 2.8 [95% CI 1.2-6.7]). The word "cascade" in titles was associated with "Drug-Related Side Effects and Adverse Reactions" (OR = 3.6 [95% CI 1.4-9.2]).<h4>Conclusion</h4>Current evidence does not support a dedicated MeSH for 'prescribing cascades' as existing descriptors are sufficient to capture its main dimensions. Further research should prioritize definitional consensus and compositional indexing strategies to enhance retrieval accuracy.
Find similar cases for your pet
PetCaseFinder finds other peer-reviewed reports of pets with the same symptoms, plus a plain-English summary of what was tried across them.
Search related cases →Original publication on Europe PMC: https://europepmc.org/article/MED/41741242