Pierre Patel

83 · male · Dementia, Hypertension, Depression

Pharmacist brief Check a new prescription Export FHIR

Medicines

Likely cascade links

Could be avoidable

Anticholinergic burden

Drugs toward falls

Dangerous combos

Root drug · likely · score 0.99

Escitalopram → 1 downstream

Escitalopram

SSRI

Zopiclone

Z-drug hypnotic

Root drug · likely · score 0.84

Amlodipine → 1 downstream

Amlodipine

Calcium channel blocker

Furosemide

Loop diuretic

Root drug · likely · score 0.74

Memantine → 1 downstream

Memantine

NMDA antagonist

Meclizine

Vestibular sedative

Feedback loop

Meclizine can cause cognitive impairment, which Memantine treats; Memantine can cause dizziness / vertigo, which Meclizine treats. Each drug can feed the problem the other is treating.

Why Domino thinks so

Escitalopram → trouble sleeping → Zopiclone

Escitalopram started May 12, 2024 · Zopiclone started Jun 28, 2024

0.99

likely

How often it causes this×0.7Insomnia is common with Escitalopram.

Timing×1Zopiclone started 7 weeks after Escitalopram, inside the usual window for insomnia (3 to 60 days).

Other reasons×1.25Zopiclone was charted for insomnia.

Published evidence×1.2Matches a documented cascade backed by expert consensus (ThinkCascades).

SSRI or SNRI → insomnia → sleep medication

Evidence: expert consensus

Real-world signal: adjusted sequence ratio 1.54 (95% CI 1.4–1.69), found in 2.5% of Ireland, 533,464 adults aged 65+.

Question for the pharmacist: Could the trouble sleeping be from the antidepressant? Morning dosing or a different agent may avoid adding a hypnotic.

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

Checked and set aside

Analysis: 10 FalkorDB queries, run in parallel, 17 ms