Medication review brief · for the pharmacist
Fatima Haddad
77 · female · Hypertension, Osteoarthritis pain, Heart failure, Atrial fibrillation
Prepared by Domino · Oct 1, 2026
Summary
1 likely prescribing cascade link. If Ramipril were reviewed, up to 1 downstream medicine might no longer be needed (6 → 4). Anticholinergic burden is 3.
Question 1
Could the dry cough be from the ACE inhibitor? Cough suppressants do not fix it; switching to an ARB usually does.
- Ramipril (Feb 24, 2026) → persistent dry cough → Benzonatate (Jul 29, 2026) · likely 0.99 · study
If reviewed: Benzonatate; medicines 6 → 4; anticholinergic burden 3 → 3; fall-risk drugs 3 → 2.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Furosemide as prescribed Dr. H. Singh (family doctor) | Sep 19, 2023 | Heart failure | ACB +1 Beers-listed |
| Metoprolol as prescribed Dr. H. Singh (family doctor) | Nov 14, 2023 | Heart failure | ACB +1 |
| Warfarin as prescribed Dr. H. Singh (family doctor) | Feb 3, 2024 | Atrial fibrillation | ACB +1 Beers-listed |
| Acetaminophen as prescribed Dr. H. Singh (family doctor) | Oct 30, 2025 | Osteoarthritis pain | |
| Ramipril as prescribed Dr. H. Singh (family doctor) | Feb 24, 2026 | Hypertension | Root of a cascade |
| Benzonatate as prescribed Dr. T. Nguyen (walk-in clinic) | Jul 29, 2026 | Dry cough | Possibly treating a side effect |
Evidence
- 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.