Dihydropyridine Calcium Channel Blocker-induced Prescribing Cascades: Signal Detection using High-throughput Sequence Symmetry Analysis

Abstract Background: Dihydropyridine calcium channel blockers (DHP-CCB) are widely prescribed antihypertensives whose adverse effects may trigger unnecessary prescribing of additional medications, termed prescribing cascades (PC). We aimed to identify potential DHP-CCB-induced PCs using high-throughput sequence symmetry analysis (HTSSA). Methods: Using Medicare claims data (2011–2020), we identified new users aged ≥66 years with continuous enrollment ≥360 days before and ≥180 days after DHP-CCB initiation. We screened for initiation of 446 “marker” drug classes within ±90 days of DHP-CCB initiation. Sequence ratios