Walter Brooks

79 · male · Hypertension, High cholesterol, Enlarged prostate (BPH), Depression

Four drugs pulling toward the same fall.

Medicines

Likely cascade links

Could be avoidable

Anticholinergic burden

Drugs toward falls

Dangerous combos

Root drug · likely · score 0.99

Sertraline → 1 downstream

Sertraline

SSRI

Zolpidem

Z-drug hypnotic

Root drug · likely · score 0.99

Tamsulosin

Alpha-1 blocker

Meclizine

Vestibular sedative

Root drug · possible · score 0.35

Lisinopril

ACE inhibitor

Benzonatate

Cough suppressant

Why Domino thinks so

Sertraline started Feb 4, 2025 · Zolpidem started Mar 7, 2025

0.99

likely

How often it causes this×0.7Insomnia is common with Sertraline.

Timing×1Zolpidem started 4 weeks after Sertraline, inside the usual window for insomnia (3 to 60 days).

Other reasons×1.25Zolpidem was charted for insomnia.

Published evidence×1.2Matches a documented cascade backed by expert consensus (ThinkCascades).

SSRI or SNRI → insomnia → sleep medication

Evidence: expert consensus

Real-world signal: adjusted sequence ratio 1.54 (95% CI 1.4–1.69), found in 2.5% of Ireland, 533,464 adults aged 65+.

Question for the pharmacist: Could the trouble sleeping be from the antidepressant? Morning dosing or a different agent may avoid adding a hypnotic.

Teach Domino. Your decision becomes memory every future review respects.

Checked and set aside

Analysis: 13 FalkorDB queries, run in parallel, 41 ms