Helen Bouchard

70 · female · Hypertension, Osteoarthritis pain, Neuropathic pain

Medicines

Likely cascade links

Could be avoidable

Anticholinergic burden

Drugs toward falls

Dangerous combos

Root drug · likely · score 0.99

Lisinopril → 1 downstream

Lisinopril

ACE inhibitor

Dextromethorphan

Cough suppressant

Root drug · likely · score 0.74

Amitriptyline

Tricyclic antidepressant

Galantamine

Cholinesterase inhibitor

Why Domino thinks so

Lisinopril started May 24, 2023 · Dextromethorphan started Aug 3, 2023

0.99

likely

How often it causes this×0.7Dry cough is common with Lisinopril.

Timing×1Dextromethorphan started 10 weeks after Lisinopril, inside the usual window for dry cough (7 to 180 days).

Other reasons×1.25Dextromethorphan was charted for dry cough.

Published evidence×1.15Matches a documented cascade backed by a published study.

ACE inhibitor → dry cough → cough suppressant

Evidence: published study

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.

Question for the pharmacist: Could the dry cough be from the ACE inhibitor? Cough suppressants do not fix it; switching to an ARB usually does.

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

Checked and set aside

Analysis: 10 FalkorDB queries, run in parallel, 16 ms