Medication review brief · for the pharmacist
Kwame Campbell
74 · male · Osteoarthritis pain, High cholesterol, Depression
Prepared by Domino · Oct 1, 2026
Summary
3 likely prescribing cascade links. If Ibuprofen were reviewed, up to 2 downstream medicines might no longer be needed (7 → 4).
Question 1
Could the raised blood pressure be from the NSAID? NSAIDs raise blood pressure and blunt most antihypertensives.
- Ibuprofen (Jun 11, 2023) → high blood pressure → Candesartan (Sep 7, 2023) · likely 0.84 · consensus
If reviewed: Omeprazole (planned companion), Candesartan; medicines 7 → 4; anticholinergic burden 2 → 2; fall-risk drugs 3 → 3.
Do not stop abruptly
- Omeprazole: Consider a step-down: stopping suddenly can cause rebound acid symptoms.
Question 2
Could the trouble sleeping be from the antidepressant? Morning dosing or a different agent may avoid adding a hypnotic.
- Citalopram (Oct 21, 2025) → trouble sleeping → Zopiclone (Nov 20, 2025) · likely 0.99 · consensus
If reviewed: Zopiclone; medicines 7 → 5; anticholinergic burden 2 → 2; fall-risk drugs 3 → 1.
Do not stop abruptly
- Citalopram: Taper if changed: stopping suddenly can cause discontinuation symptoms.
- Zopiclone: Taper if changed: stopping suddenly can cause rebound insomnia.
Question 3
Could muscle aches be from Rosuvastatin?
- Rosuvastatin (Oct 9, 2024) → muscle aches → Cyclobenzaprine (Dec 31, 2024) · likely 0.59 · graph-inferred
If reviewed: Cyclobenzaprine; medicines 7 → 5; anticholinergic burden 2 → 0; fall-risk drugs 3 → 2.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Ibuprofen as prescribed Dr. J. Martin (family doctor) | Jun 11, 2023 | Osteoarthritis pain | Root of a cascade Beers-listed |
| Omeprazole as prescribed Dr. J. Martin (family doctor) | Jun 13, 2023 | GI bleeding risk | Beers-listed |
| Candesartan as prescribed Dr. J. Martin (family doctor) | Sep 7, 2023 | — | Possibly treating a side effect |
| Rosuvastatin as prescribed Dr. J. Martin (family doctor) | Oct 9, 2024 | High cholesterol | Root of a cascade |
| Cyclobenzaprine as prescribed Dr. T. Nguyen (walk-in clinic) | Dec 31, 2024 | — | Possibly treating a side effect ACB +2 Beers-listed |
| Citalopram |
Evidence
- McCarthy LM, et al. ThinkCascades: A Tool for Identifying Clinically Important Prescribing Cascades Affecting Older People. Drugs Aging. 2022;39(10):829-840.
- Gurwitz JH, et al. Initiation of antihypertensive treatment during nonsteroidal anti-inflammatory drug therapy. JAMA. 1994;272(10):781-786.
- Doherty AS, Lund LC, Moriarty F, et al. Prescribing Cascades Among Older Community-Dwelling Adults: Application of Prescription Sequence Symmetry Analysis to a National Database in Ireland. Ann Fam Med. 2025;23(4):315-324.
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.