Medication review brief · for the pharmacist
Olga Reid
96 · female · Heart failure
Prepared by Domino · Oct 1, 2026
Summary
3 likely prescribing cascade links. If Lisinopril were reviewed, up to 2 downstream medicines might no longer be needed (6 → 3). Anticholinergic burden is 7.
Question 1
Could the dry cough be from the ACE inhibitor? Cough suppressants do not fix it; switching to an ARB usually does.
- Lisinopril (Dec 17, 2025) → persistent dry cough → Dextromethorphan (Dec 28, 2025) · likely 0.99 · study
- Lisinopril (Dec 17, 2025) → dizziness or spinning → Dimenhydrinate (Jan 11, 2026) · possible 0.34 · graph-inferred
If reviewed: Dextromethorphan, Dimenhydrinate; medicines 6 → 3; anticholinergic burden 7 → 4; fall-risk drugs 5 → 2.
Question 2
Could the urgency or leaking be from the diuretic? Changing the timing of the dose can help before adding a bladder medication.
- Furosemide (Oct 29, 2025) → leaking urine, urgency → Tolterodine (Nov 16, 2025) · likely 0.99 · consensus
- Tolterodine (Nov 16, 2025) → constipation → Senna (Dec 18, 2025) · likely 0.59 · graph-inferred
If reviewed: Tolterodine, Senna; medicines 6 → 3; anticholinergic burden 7 → 3; fall-risk drugs 5 → 3.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Furosemide as prescribed Dr. J. Martin (family doctor) | Oct 29, 2025 | Heart failure | Root of a cascade ACB +1 Beers-listed |
| Tolterodine as prescribed Dr. R. Ahmed (walk-in clinic) | Nov 16, 2025 | Urinary incontinence | Possibly treating a side effect ACB +3 Beers-listed |
| Lisinopril as prescribed Dr. J. Martin (family doctor) | Dec 17, 2025 | Heart failure | Root of a cascade |
| Senna as prescribed Dr. R. Ahmed (walk-in clinic) | Dec 18, 2025 | — | Possibly treating a side effect |
| Dextromethorphan as prescribed Dr. J. Martin (family doctor) | Dec 28, 2025 | Dry cough | Possibly treating a side effect |
| Dimenhydrinate |
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.
- McCarthy LM, et al. ThinkCascades: A Tool for Identifying Clinically Important Prescribing Cascades Affecting Older People. Drugs Aging. 2022;39(10):829-840.
- 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.