Agnes Andersen

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

Prepared by Domino · Oct 1, 2026

Summary

2 likely prescribing cascade links. If Solifenacin were reviewed, up to 1 downstream medicine might no longer be needed (8 → 6). Anticholinergic burden is 4.

Question 1

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

Solifenacin (Jun 4, 2023) → confusion or memory problems → Rivastigmine (Nov 27, 2023) · likely 0.60 · consensus

If reviewed: Rivastigmine; medicines 8 → 6; anticholinergic burden 4 → 1; fall-risk drugs 5 → 3.

Question 2

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

Citalopram (Jan 20, 2026) → trouble sleeping → Trazodone (Mar 13, 2026) · likely 0.99 · consensus

If reviewed: no downstream change; medicines 8 → 7; anticholinergic burden 4 → 4; fall-risk drugs 5 → 4.

Do not stop abruptly

Citalopram: Taper if changed: stopping suddenly can cause discontinuation symptoms.

Medicines

Medicine	Started	Charted for	Domino
Simvastatin as prescribed Dr. A. Patel (family doctor)	Jan 19, 2023	High cholesterol
Solifenacin as prescribed Dr. M. Fischer (urology)	Jun 4, 2023	Urinary incontinence	Root of a cascade ACB +3 Beers-listed
Hydrochlorothiazide as prescribed Dr. A. Patel (family doctor)	Nov 27, 2023	Hypertension	Beers-listed
Rivastigmine as prescribed Dr. R. Ahmed (walk-in clinic)	Nov 27, 2023	Cognitive impairment	Possibly treating a side effect
Levothyroxine as prescribed Dr. A. Patel (family doctor)	Jun 15, 2024	Hypothyroidism
Diclofenac as prescribed

Evidence

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.