Medication review brief · for the pharmacist
Elaine Bergeron
90 · female · Hypertension, Parkinson's disease, Type 2 diabetes, Anxiety
Prepared by Domino · Oct 1, 2026
Summary
3 likely prescribing cascade links. If Lorazepam were reviewed, up to 3 downstream medicines might no longer be needed (7 → 3). Anticholinergic burden is 4.
Question 1
Could the memory problems be from the benzodiazepine? Benzodiazepines impair memory and attention in older adults.
- Lorazepam (Sep 7, 2023) → confusion or memory problems → Donepezil (Mar 3, 2024) · likely 0.99 · consensus
- Donepezil (Mar 3, 2024) → diarrhoea → Loperamide (Mar 10, 2024) · likely 0.59 · graph-inferred
- Lorazepam (Sep 7, 2023) → agitation, restlessness or delirium → Olanzapine (Sep 15, 2023) · likely 0.60 · consensus
If reviewed: Olanzapine, Donepezil, Loperamide; medicines 7 → 3; anticholinergic burden 4 → 0; fall-risk drugs 6 → 3.
Do not stop abruptly
- Lorazepam: Taper slowly if changed: stopping suddenly can cause withdrawal, including seizures.
- Olanzapine: Taper if changed: stopping suddenly can cause withdrawal symptoms or relapse.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Lorazepam as prescribed Dr. E. Okoro (psychiatry) | Sep 7, 2023 | Anxiety | Root of a cascade Beers-listed |
| Olanzapine as prescribed Dr. J. Martin (family doctor) | Sep 15, 2023 | Agitation / delirium | Possibly treating a side effect ACB +3 Beers-listed |
| Donepezil as prescribed Dr. L. Romero (geriatrics) | Mar 3, 2024 | Cognitive impairment | Possibly treating a side effect |
| Empagliflozin as prescribed Dr. J. Martin (family doctor) | Mar 6, 2024 | Type 2 diabetes | |
| Loperamide as prescribed Dr. R. Ahmed (walk-in clinic) | Mar 10, 2024 | — | Possibly treating a side effect ACB +1 |
| Lisinopril |
Evidence
- McCarthy LM, et al. ThinkCascades: A Tool for Identifying Clinically Important Prescribing Cascades Affecting Older People. Drugs Aging. 2022;39(10):829-840.
- 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.