Doris Hughes

94 · female · Dry cough, High cholesterol, Depression, Osteoporosis

Medicines

Likely cascade links

Could be avoidable

Anticholinergic burden

Drugs toward falls

Dangerous combos

Root drug · likely · score 0.99

Duloxetine → 1 downstream

Duloxetine

SNRI

Zopiclone

Z-drug hypnotic

Root drug · likely · score 0.70

Alendronate

Bisphosphonate

Pantoprazole

Proton pump inhibitor

Why Domino thinks so

Duloxetine started May 7, 2026 · Zopiclone started Jun 3, 2026

0.99

likely

How often it causes this×0.7Insomnia is common with Duloxetine.

Timing×1Zopiclone started 4 weeks after Duloxetine, inside the usual window for insomnia (3 to 60 days).

Other reasons×1.25Zopiclone was charted for insomnia.

Published evidence×1.2Matches a documented cascade backed by expert consensus (ThinkCascades).

SSRI or SNRI → insomnia → sleep medication

Evidence: expert consensus

Real-world signal: adjusted sequence ratio 1.54 (95% CI 1.4–1.69), found in 2.5% of Ireland, 533,464 adults aged 65+.

Question for the pharmacist: Could the trouble sleeping be from the antidepressant? Morning dosing or a different agent may avoid adding a hypnotic.

Teach Domino. Your decision becomes memory every future review respects.

Analysis: 10 FalkorDB queries, run in parallel, 16 ms