Medication review brief · for the pharmacist
Kenji Yamamoto
95 · male · Hypertension, Reflux / indigestion, Coronary artery disease, Depression
Prepared by Domino · Oct 1, 2026
Summary
1 likely prescribing cascade link. If Amlodipine were reviewed, up to 1 downstream medicine might no longer be needed (6 → 4). Dangerous combination: bleeding stack. 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 (May 13, 2025) → ankle and leg swelling → Hydrochlorothiazide (Jun 7, 2025) · likely 0.99 · consensus
- Amlodipine (May 13, 2025) → dizziness or spinning → Dimenhydrinate (May 22, 2025) · possible 0.34 · graph-inferred
If reviewed: Dimenhydrinate; medicines 6 → 4; anticholinergic burden 3 → 0; fall-risk drugs 4 → 2.
Combinations
- Bleeding stack (Clopidogrel + Sertraline): An anticoagulant or antiplatelet combined with an NSAID or SSRI/SNRI raises bleeding risk.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Clopidogrel as prescribed Dr. J. Martin (family doctor) | Oct 16, 2022 | Coronary artery disease | |
| Sertraline as prescribed Dr. J. Martin (family doctor) | Jan 19, 2025 | Depression | Beers-listed |
| Pantoprazole as prescribed Dr. J. Martin (family doctor) | Mar 16, 2025 | Reflux / indigestion | Beers-listed |
| Amlodipine as prescribed Dr. J. Martin (family doctor) | May 13, 2025 | Hypertension | Root of a cascade |
| Dimenhydrinate as prescribed Dr. T. Nguyen (walk-in clinic) | May 22, 2025 | — | Possibly treating a side effect ACB +3 Beers-listed |
| Hydrochlorothiazide as prescribed Dr. J. Martin (family doctor) | Jun 7, 2025 | 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.
- American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081.
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.