Agnes Andersen

65 · female · Urinary incontinence, Hypertension, Hypothyroidism, Osteoarthritis pain, High cholesterol, Depression

Pharmacist brief Check a new prescription Export FHIR

Medicines

Likely cascade links

Could be avoidable

Anticholinergic burden

Drugs toward falls

Dangerous combos

Root drug · likely · score 0.60

Solifenacin → 1 downstream

Solifenacin

Urinary antimuscarinic

Rivastigmine

Cholinesterase inhibitor

Root drug · likely · score 0.99

Citalopram → 1 downstream

Citalopram

SSRI

Trazodone

Sedating antidepressant

Why Domino thinks so

Solifenacin → confusion or memory problems → Rivastigmine

Solifenacin started Jun 4, 2023 · Rivastigmine started Nov 27, 2023

0.60

likely

How often it causes this×0.4Cognitive impairment is uncommon with Solifenacin.

Timing×1Rivastigmine started 6 months after Solifenacin, inside the usual window for cognitive impairment (7 to 180 days).

Other reasons×1.25Rivastigmine was charted for cognitive impairment.

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

Bladder antimuscarinic → memory problems → dementia medication

Evidence: expert consensus

Inconclusive in the Irish national data (confidence interval crosses 1).

Question for the pharmacist: Could the confusion be from the strongly anticholinergic bladder medication? Treating it with a dementia drug can create a loop.

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

Checked and set aside

Analysis: 10 FalkorDB queries, run in parallel, 22 ms