Kenji Yamamoto

95 · male · Hypertension, Reflux / indigestion, Coronary artery disease, Depression

Pharmacist brief Check a new prescription Export FHIR

Medicines

Likely cascade links

Could be avoidable

Anticholinergic burden

Drugs toward falls

Dangerous combos

Root drug · likely · score 0.99

Amlodipine → 2 downstream

Amlodipine

Calcium channel blocker

Hydrochlorothiazide

Thiazide diuretic

Dimenhydrinate

Vestibular sedative

Why Domino thinks so

Amlodipine → ankle and leg swelling → Hydrochlorothiazide

Amlodipine started May 13, 2025 · Hydrochlorothiazide started Jun 7, 2025

0.99

likely

How often it causes this×0.7Peripheral edema is common with Amlodipine.

Timing×1Hydrochlorothiazide started 4 weeks after Amlodipine, inside the usual window for peripheral edema (7 to 120 days).

Other reasons×1.25Hydrochlorothiazide was charted for peripheral edema.

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

Calcium channel blocker → ankle swelling → diuretic

Evidence: expert consensus

Real-world signal: adjusted sequence ratio 1.93 (95% CI 1.79–2.09), found in 2.6% of Ireland, 533,464 adults aged 65+.

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.

Question for the pharmacist: 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.

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

Checked and set aside

Analysis: 10 FalkorDB queries, run in parallel, 17 ms