Medication review brief · for the pharmacist
Kenji Haddad
90 · male · Hypertension, Hypothyroidism, Type 2 diabetes, Osteoarthritis pain, Enlarged prostate (BPH)
Prepared by Domino · Oct 1, 2026
Summary
1 likely prescribing cascade link. If Naproxen were reviewed, up to 3 downstream medicines might no longer be needed (7 → 3).
Question 1
Could the raised blood pressure be from the NSAID? NSAIDs raise blood pressure and blunt most antihypertensives.
- Naproxen (Feb 25, 2025) → high blood pressure → Losartan (Mar 19, 2025) · likely 0.99 · consensus
If reviewed: Omeprazole (planned companion), Losartan, Pantoprazole (planned companion); medicines 7 → 3; anticholinergic burden 0 → 0; fall-risk drugs 1 → 0.
Do not stop abruptly
- Omeprazole: Consider a step-down: stopping suddenly can cause rebound acid symptoms.
- Pantoprazole: Consider a step-down: stopping suddenly can cause rebound acid symptoms.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Levothyroxine as prescribed Dr. A. Patel (family doctor) | Sep 8, 2022 | Hypothyroidism | |
| Finasteride as prescribed Dr. M. Fischer (urology) | Jun 8, 2024 | Enlarged prostate (BPH) | |
| Naproxen as prescribed Dr. A. Patel (family doctor) | Feb 25, 2025 | Osteoarthritis pain | Root of a cascade Beers-listed |
| Omeprazole as prescribed Dr. A. Patel (family doctor) | Feb 28, 2025 | GI bleeding risk | Beers-listed |
| Losartan as prescribed Dr. A. Patel (family doctor) | Mar 19, 2025 | Hypertension | Possibly treating a side effect |
| Pantoprazole as prescribed Dr. R. Ahmed (walk-in clinic) | Aug 3, 2025 | — | Beers-listed |
| Metformin 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.
- Gurwitz JH, et al. Initiation of antihypertensive treatment during nonsteroidal anti-inflammatory drug therapy. JAMA. 1994;272(10):781-786.
- 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.