Medication review brief · for the pharmacist
Luis Mensah
84 · male · Hypertension, Reflux / indigestion, Hypothyroidism, Coronary artery disease, High cholesterol
Prepared by Domino · Oct 1, 2026
Summary
2 likely prescribing cascade links. If Lisinopril were reviewed, up to 1 downstream medicine might no longer be needed (7 → 5). Dangerous combination: bleeding stack.
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 26, 2022) → persistent dry cough → Benzonatate (Mar 6, 2023) · likely 0.99 · study
If reviewed: Benzonatate; medicines 7 → 5; anticholinergic burden 0 → 0; fall-risk drugs 3 → 1.
Question 2
Could muscle aches be from Rosuvastatin?
- Rosuvastatin (Jul 19, 2024) → muscle aches → Ibuprofen (Nov 9, 2024) · likely 0.74 · graph-inferred
If reviewed: Ibuprofen; medicines 7 → 5; anticholinergic burden 0 → 0; fall-risk drugs 3 → 3.
Combinations
- Bleeding stack (Aspirin (low dose) + Ibuprofen): An anticoagulant or antiplatelet combined with an NSAID or SSRI/SNRI raises bleeding risk.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Lisinopril as prescribed Dr. H. Singh (family doctor) | Dec 26, 2022 | Hypertension | Root of a cascade |
| Famotidine as prescribed Dr. H. Singh (family doctor) | Feb 17, 2023 | Reflux / indigestion | |
| Benzonatate as prescribed Dr. T. Nguyen (walk-in clinic) | Mar 6, 2023 | Dry cough | Possibly treating a side effect |
| Levothyroxine as prescribed Dr. H. Singh (family doctor) | Nov 12, 2023 | — | |
| Rosuvastatin as prescribed Dr. H. Singh (family doctor) | Jul 19, 2024 | High cholesterol | Root of a cascade |
| Ibuprofen as prescribed Dr. T. Nguyen (walk-in clinic) | Nov 9, 2024 | Myalgia |
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.
- American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081.
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.