Medication review brief · for the pharmacist
Walter Brooks
79 · male · Hypertension, High cholesterol, Enlarged prostate (BPH), Depression
Prepared by Domino · Oct 1, 2026
Summary
2 likely prescribing cascade links. If Sertraline were reviewed, up to 1 downstream medicine might no longer be needed (8 → 6). Anticholinergic burden is 3.
Question 1
Could the trouble sleeping be from the antidepressant? Morning dosing or a different agent may avoid adding a hypnotic.
- Sertraline (Feb 4, 2025) → trouble sleeping → Zolpidem (Mar 7, 2025) · likely 0.99 · consensus
If reviewed: Zolpidem; medicines 8 → 6; anticholinergic burden 3 → 3; fall-risk drugs 6 → 4.
Do not stop abruptly
- Sertraline: Taper if changed: stopping suddenly can cause discontinuation symptoms.
- Zolpidem: Taper if changed: stopping suddenly can cause rebound insomnia.
Question 2
Could the dizziness be from the alpha blocker (often on standing)? Vestibular sedatives are strongly anticholinergic and add fall risk.
- Tamsulosin (Jul 19, 2024) → dizziness or spinning → Meclizine (Aug 12, 2024) · likely 0.99 · consensus
If reviewed: Meclizine; medicines 8 → 6; anticholinergic burden 3 → 0; fall-risk drugs 6 → 4.
Question 3
Could the dry cough be from the ACE inhibitor? Cough suppressants do not fix it; switching to an ARB usually does.
- Lisinopril (Jan 31, 2022) → persistent dry cough → Benzonatate (Oct 2, 2025) · possible 0.35 · study
If reviewed: Benzonatate; medicines 8 → 6; anticholinergic burden 3 → 3; fall-risk drugs 6 → 4.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Atorvastatin 40 mg daily Dr. A. Patel (family doctor) | Jul 15, 2021 | High cholesterol | |
| Lisinopril 20 mg daily Dr. A. Patel (family doctor) | Jan 31, 2022 | Hypertension | Root of a cascade |
| Tamsulosin 0.4 mg daily Dr. M. Fischer (urology) | Jul 19, 2024 | Enlarged prostate (BPH) | Root of a cascade |
| Meclizine 25 mg as needed Dr. R. Ahmed (walk-in clinic) | Aug 12, 2024 | Dizziness / vertigo | Possibly treating a side effect ACB +3 Beers-listed |
| Finasteride 5 mg daily Dr. M. Fischer (urology) | Sep 25, 2024 | — | |
| Sertraline 50 mg daily Dr. A. Patel (family doctor) |
Evidence
- McCarthy LM, et al. ThinkCascades: A Tool for Identifying Clinically Important Prescribing Cascades Affecting Older People. Drugs Aging. 2022;39(10):829-840.
- Doherty AS, Lund LC, Moriarty F, et al. Prescribing Cascades Among Older Community-Dwelling Adults: Application of Prescription Sequence Symmetry Analysis to a National Database in Ireland. Ann Fam Med. 2025;23(4):315-324.
- Vegter S, de Jong-van den Berg LTW. Misdiagnosis and mistreatment of a common side-effect: angiotensin-converting enzyme inhibitor-induced cough. Br J Clin Pharmacol. 2010;69(2):200-203.
Decision support only. Domino flags patterns in a synthetic record for a clinician to review; it does not diagnose, and it never recommends stopping or changing a medicine. Synthetic data; no real patient.