Helen Bouchard

70 · female · Hypertension, Osteoarthritis pain, Neuropathic pain

Prepared by Domino · Oct 1, 2026

Summary

2 likely prescribing cascade links. If Lisinopril 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.

Lisinopril (May 24, 2023) → persistent dry cough → Dextromethorphan (Aug 3, 2023) · likely 0.99 · study

If reviewed: Dextromethorphan; medicines 6 → 4; anticholinergic burden 3 → 3; fall-risk drugs 5 → 3.

Question 2

Could confusion or memory problems be from Amitriptyline?

Amitriptyline (Nov 30, 2023) → confusion or memory problems → Galantamine (Feb 27, 2024) · likely 0.74 · graph-inferred

If reviewed: Galantamine; medicines 6 → 4; anticholinergic burden 3 → 0; fall-risk drugs 5 → 3.

Do not stop abruptly

Amitriptyline: Taper if changed: stopping suddenly can cause discontinuation symptoms.

Medicines

Medicine	Started	Charted for	Domino
Lisinopril as prescribed Dr. A. Patel (family doctor)	May 24, 2023	Hypertension	Root of a cascade
Dextromethorphan as prescribed Dr. R. Ahmed (walk-in clinic)	Aug 3, 2023	Dry cough	Possibly treating a side effect
Oxycodone as prescribed Dr. A. Patel (family doctor)	Sep 25, 2023	Osteoarthritis pain
Polyethylene glycol as prescribed Dr. A. Patel (family doctor)	Sep 26, 2023	Constipation
Amitriptyline as prescribed Dr. A. Patel (family doctor)	Nov 30, 2023	—	Root of a cascade ACB +3 Beers-listed
Galantamine as prescribed Dr. R. Ahmed (walk-in clinic)

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.