Mei Tremblay

68 · female · Hypertension, High cholesterol, Anxiety, Osteoporosis

Medicines

Likely cascade links

Could be avoidable

Anticholinergic burden

Drugs toward falls

Dangerous combos

Root drug · likely · score 0.99

Lisinopril → 2 downstream

Lisinopril

ACE inhibitor

Benzonatate

Cough suppressant

Betahistine

Non-sedating antivertigo agent

Root drug · likely · score 0.70

Alendronate

Bisphosphonate

Pantoprazole

Proton pump inhibitor

Also feeding this chain: Sertraline → stomach irritation or bleeding risk → Pantoprazole (possible, 0.34).

Why Domino thinks so

Lisinopril started Jul 6, 2024 · Benzonatate started Aug 9, 2024

0.99

likely

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

Timing×1Benzonatate started 5 weeks after Lisinopril, inside the usual window for dry cough (7 to 180 days).

Other reasons×1.25Benzonatate 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, 15 ms