Louise Ferreira

89 · female · Hypertension, Osteoarthritis pain, High cholesterol, Depression, Osteoporosis

Prepared by Domino · Oct 1, 2026

Summary

3 likely prescribing cascade links. If Naproxen were reviewed, up to 2 downstream medicines might no longer be needed (9 → 6).

Question 1

Could ankle and leg swelling be from Naproxen?

Naproxen (Oct 31, 2025) → ankle and leg swelling → Torsemide (Dec 18, 2025) · likely 0.59 · graph-inferred

If reviewed: Omeprazole (planned companion), Torsemide; medicines 9 → 6; anticholinergic burden 0 → 0; fall-risk drugs 3 → 2.

Do not stop abruptly

Omeprazole: Consider a step-down: stopping suddenly can cause rebound acid symptoms.

Question 2

Could the gout be from the diuretic raising uric acid? A different antihypertensive may be an option.

Hydrochlorothiazide (Sep 22, 2023) → gout or high uric acid → Allopurinol (May 22, 2024) · likely 0.99 · study
Hydrochlorothiazide (Sep 22, 2023) → low potassium → Spironolactone (Oct 9, 2023) · likely 0.74 · graph-inferred

If reviewed: Allopurinol; medicines 9 → 7; anticholinergic burden 0 → 0; fall-risk drugs 3 → 2.

Medicines

Medicine	Started	Charted for	Domino
Calcium + vitamin D as prescribed Dr. J. Martin (family doctor)	May 9, 2023	Osteoporosis
Hydrochlorothiazide as prescribed Dr. J. Martin (family doctor)	Sep 22, 2023	Hypertension	Root of a cascade Beers-listed
Spironolactone as prescribed Dr. J. Martin (family doctor)	Oct 9, 2023	Hypokalaemia	Possibly treating a side effect
Mirtazapine as prescribed Dr. J. Martin (family doctor)	Feb 15, 2024	Depression
Atorvastatin as prescribed Dr. J. Martin (family doctor)	May 22, 2024	High cholesterol
Allopurinol as prescribed Dr. J. Martin (family doctor)	May 22, 2024

Evidence

Rochon PA, Gurwitz JH. The prescribing cascade revisited. Lancet. 2017;389(10081):1778-1780.

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.