Medication review brief · for the pharmacist
Mei Tremblay
68 · female · Hypertension, High cholesterol, Anxiety, Osteoporosis
Prepared by Domino · Oct 1, 2026
Summary
2 likely prescribing cascade links. If Lisinopril were reviewed, up to 2 downstream medicines might no longer be needed (7 → 4).
Question 1
Could the dry cough be from the ACE inhibitor? Cough suppressants do not fix it; switching to an ARB usually does.
- Lisinopril (Jul 6, 2024) → persistent dry cough → Benzonatate (Aug 9, 2024) · likely 0.99 · study
- Lisinopril (Jul 6, 2024) → dizziness or spinning → Betahistine (Jul 8, 2024) · possible 0.34 · graph-inferred
If reviewed: Betahistine, Benzonatate; medicines 7 → 4; anticholinergic burden 0 → 0; fall-risk drugs 3 → 1.
Question 2
Could the indigestion be from the bisphosphonate (and how it is taken)?
- Alendronate (Nov 12, 2025) → heartburn or indigestion → Pantoprazole (Dec 6, 2025) · likely 0.70 · label
If reviewed: Pantoprazole; medicines 7 → 5; anticholinergic burden 0 → 0; fall-risk drugs 3 → 3.
Do not stop abruptly
- Pantoprazole: Consider a step-down: stopping suddenly can cause rebound acid symptoms.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Rosuvastatin as prescribed Dr. A. Patel (family doctor) | Mar 22, 2024 | — | |
| Lisinopril as prescribed Dr. A. Patel (family doctor) | Jul 6, 2024 | Hypertension | Root of a cascade |
| Betahistine as prescribed Dr. T. Nguyen (walk-in clinic) | Jul 8, 2024 | — | Possibly treating a side effect |
| Benzonatate as prescribed Dr. A. Patel (family doctor) | Aug 9, 2024 | Dry cough | Possibly treating a side effect |
| Sertraline as prescribed Dr. A. Patel (family doctor) | Oct 11, 2025 | Anxiety | Beers-listed |
| Alendronate as prescribed Dr. A. Patel (family doctor) | Nov 12, 2025 |
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.
- Product monographs and prescribing information (adverse reaction sections), curated by hand for this prototype. Frequencies are approximate bands, not exact rates.
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.