Medication review brief · for the pharmacist
Grace Kaur
96 · female · Hypertension
Prepared by Domino · Oct 1, 2026
Summary
1 likely prescribing cascade link. If Amlodipine were reviewed, up to 3 downstream medicines might no longer be needed (4 → 0). Anticholinergic burden is 3.
Question 1
Could the ankle swelling be from the calcium channel blocker? CCB edema does not respond well to diuretics; a dose change or a different antihypertensive may help instead.
- Amlodipine (Nov 24, 2025) → ankle and leg swelling → Torsemide (Feb 21, 2026) · likely 0.99 · consensus
- Amlodipine (Nov 24, 2025) → dizziness or spinning → Meclizine (Jan 1, 2026) · possible 0.42 · graph-inferred
- Meclizine (Jan 1, 2026) → constipation → Senna (Jan 10, 2026) · possible 0.34 · graph-inferred
If reviewed: Meclizine, Senna, Torsemide; medicines 4 → 0; anticholinergic burden 3 → 0; fall-risk drugs 3 → 0.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Amlodipine as prescribed Dr. A. Patel (family doctor) | Nov 24, 2025 | Hypertension | Root of a cascade |
| Meclizine as prescribed Dr. R. Ahmed (walk-in clinic) | Jan 1, 2026 | Dizziness / vertigo | Possibly treating a side effect ACB +3 Beers-listed |
| Senna as prescribed Dr. R. Ahmed (walk-in clinic) | Jan 10, 2026 | — | Possibly treating a side effect |
| Torsemide as prescribed Dr. A. Patel (family doctor) | Feb 21, 2026 | Peripheral edema | Possibly treating a side effect Beers-listed |
Evidence
- McCarthy LM, et al. ThinkCascades: A Tool for Identifying Clinically Important Prescribing Cascades Affecting Older People. Drugs Aging. 2022;39(10):829-840.
- Savage RD, et al. Evaluation of a Common Prescribing Cascade of Calcium Channel Blockers and Diuretics in Older Adults With Hypertension. JAMA Intern Med. 2020;180(5):643-651.
- 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.