Medication review brief · for the pharmacist
Grace Mensah
79 · female · Hypertension, High cholesterol
Prepared by Domino · Oct 1, 2026
Summary
1 likely prescribing cascade link. If Ramipril were reviewed, up to 1 downstream medicine might no longer be needed (3 → 1).
Question 1
Could the dry cough be from the ACE inhibitor? Cough suppressants do not fix it; switching to an ARB usually does.
- Ramipril (Mar 31, 2026) → persistent dry cough → Dextromethorphan (May 15, 2026) · likely 0.99 · study
If reviewed: Dextromethorphan; medicines 3 → 1; anticholinergic burden 0 → 0; fall-risk drugs 1 → 0.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Atorvastatin as prescribed Dr. J. Martin (family doctor) | Dec 11, 2025 | High cholesterol | |
| Ramipril as prescribed Dr. J. Martin (family doctor) | Mar 31, 2026 | Hypertension | Root of a cascade |
| Dextromethorphan as prescribed Dr. R. Ahmed (walk-in clinic) | May 15, 2026 | Dry cough | Possibly treating a side effect |
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.
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.