Medication review brief · for the pharmacist
Amara Li
87 · female · Hypertension, Insomnia, Reflux / indigestion, Osteoarthritis pain, High cholesterol
Prepared by Domino · Oct 1, 2026
Summary
8 likely prescribing cascade links. If Celecoxib were reviewed, up to 7 downstream medicines might no longer be needed (13 → 5). Anticholinergic burden is 6.
Question 1
Could the raised blood pressure be from the NSAID? NSAIDs raise blood pressure and blunt most antihypertensives.
- Celecoxib (Aug 6, 2023) → high blood pressure → Felodipine (Sep 21, 2023) · likely 0.84 · consensus
- Felodipine (Sep 21, 2023) → ankle and leg swelling → Furosemide (Oct 7, 2023) · likely 0.99 · consensus
- Furosemide (Oct 7, 2023) → leaking urine, urgency → Vibegron (Dec 10, 2023) · likely 0.84 · consensus
- Felodipine (Sep 21, 2023) → ankle and leg swelling → Torsemide (Dec 23, 2023) · likely 0.84 · consensus
- Celecoxib (Aug 6, 2023) → ankle and leg swelling → Furosemide (Oct 7, 2023) · likely 0.74 · graph-inferred
- Celecoxib (Aug 6, 2023) → high blood pressure → Nifedipine (Nov 12, 2023) · likely 0.63 · consensus
- Nifedipine (Nov 12, 2023) → ankle and leg swelling → Torsemide (Dec 23, 2023) · likely 0.84 · consensus
- Furosemide (Oct 7, 2023) → light-headed on standing → Midodrine (Oct 28, 2023) · possible 0.34 · graph-inferred
- Nifedipine (Nov 12, 2023) → dizziness or spinning → Dimenhydrinate (Dec 3, 2023) · likely 0.59 · graph-inferred
- Celecoxib (Aug 6, 2023) → ankle and leg swelling → Torsemide (Dec 23, 2023) · possible 0.36 · graph-inferred
If reviewed: Felodipine, Furosemide, Midodrine, Nifedipine, Dimenhydrinate, Vibegron, Torsemide; medicines 13 → 5; anticholinergic burden 6 → 1; fall-risk drugs 6 → 2.
Question 2
Could low vitamin b12 be from Pantoprazole?
- Pantoprazole (Oct 24, 2023) → low vitamin b12 → Vitamin B12 (Aug 26, 2026) · possible 0.34 · graph-inferred
If reviewed: Vitamin B12; medicines 13 → 11; anticholinergic burden 6 → 6; fall-risk drugs 6 → 6.
Do not stop abruptly
- Pantoprazole: Consider a step-down: stopping suddenly can cause rebound acid symptoms.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Celecoxib as prescribed Dr. A. Patel (family doctor) | Aug 6, 2023 | Osteoarthritis pain | Root of a cascade Beers-listed |
| Felodipine as prescribed Dr. A. Patel (family doctor) | Sep 21, 2023 | — | Possibly treating a side effect |
| Furosemide as prescribed Dr. K. Osei (cardiology) | Oct 7, 2023 | Peripheral edema | Possibly treating a side effect ACB +1 Beers-listed |
| Pantoprazole as prescribed Dr. T. Nguyen (walk-in clinic) | Oct 24, 2023 | — | Root of a cascade Beers-listed |
| Midodrine as prescribed Dr. T. Nguyen (walk-in clinic) | Oct 28, 2023 | — | Possibly treating a side effect |
| Nifedipine |
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.
- 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.
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.