title: Successful intervention to mitigate an acetylcholinesterase inhibitor-induced rhinorrhea prescribing cascade: a case report.
abstract: OBJECTIVE
  A prescribing cascade if often treated by discontinuing both medications. We describe an intervention to mitigate a prescribing cascade while continuing a clinically necessary medication without negatively impacting the patient.
  
  
  METHODS
  A 77-year-old women experienced probable acetylcholinesterase inhibitor-induced rhinorrhea and subsequently self-medicated with diphenhydramine which lead to worsening cognitive function. We reduced the dose of the acetylcholinesterase inhibitor and discontinued the diphenhydramine. The symptoms of rhinorrhea were subsequently reduced without negatively impacting cognition.
  
  
  CONCLUSIONS
  This was the first published prescribing cascade intervention that did not require discontinuation of both medications, which may be emulated in future prescribing cascade cases.
authors.affiliation: Department of Pharmacy Practice, Center for Health Outcomes Research and Education, St. Louis College of Pharmacy, St. Louis, MO, USA.
authors.forename: S M
authors.identifier: http://orcid.org/0000-0002-0411-2160
authors.initials: SM
authors.lastname: Vouri
authors.affiliation: Mercy Clinic Internal Medicine and Geriatrics - Old Tesson, St. Louis, MO, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Chung
authors.affiliation: Division of Geriatrics and Nutritional Science, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
authors.forename: E F
authors.initials: EF
authors.lastname: Binder
mesh_terms: D000368:Aged; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D003071:Cognition / Q000187:drug effects; D004155:Diphenhydramine / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D012220:Rhinitis / Q000139:chemically induced / Q000175:diagnosis*; D012651:Self Medication
chemical_list: D002800:Cholinesterase Inhibitors; D004155:Diphenhydramine
keywords: adverse event; clinical pharmacy; cognition; elderly; prescribing cascade