Marie Patel

91 · female · Hypertension, Anxiety

Medicines

Likely cascade links

Could be avoidable

Anticholinergic burden

Drugs toward falls

Dangerous combos

Root drug · likely · score 0.66

Sertraline → 4 downstream

Sertraline

SSRI

Trazodone

Sedating antidepressant

Midodrine

Oral vasopressor

Felodipine

Calcium channel blocker

Lisinopril

ACE inhibitor

Root drug · likely · score 0.99

Lisinopril

ACE inhibitor

Dextromethorphan

Cough suppressant

Why Domino thinks so

Sertraline started Dec 7, 2022 · Trazodone started Dec 22, 2022

0.99

likely

How often it causes this×0.7Insomnia is common with Sertraline.

Timing×1Trazodone started 2 weeks after Sertraline, inside the usual window for insomnia (3 to 60 days).

Other reasons×1.25Trazodone was charted for insomnia.

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

SSRI or SNRI → insomnia → sleep medication

Evidence: expert consensus

Real-world signal: adjusted sequence ratio 1.54 (95% CI 1.4–1.69), found in 2.5% of Ireland, 533,464 adults aged 65+.

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

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

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