Medication review brief · for the pharmacist
Kwame Bouchard
69 · male · Urinary incontinence, Hypertension, Enlarged prostate (BPH)
Prepared by Domino · Oct 1, 2026
Summary
5 likely prescribing cascade links. If Oxybutynin were reviewed, up to 1 downstream medicine might no longer be needed (7 → 5). Anticholinergic burden is 7.
Question 1
Could the confusion be from the strongly anticholinergic bladder medication? Treating it with a dementia drug can create a loop.
- Oxybutynin (Apr 20, 2025) → confusion or memory problems → Galantamine (Sep 25, 2025) · likely 0.84 · consensus
- Oxybutynin (Apr 20, 2025) → confusion or memory problems → Donepezil (Jun 29, 2025) · likely 0.84 · consensus
- Donepezil (Jun 29, 2025) → diarrhoea → Loperamide (Jul 18, 2025) · likely 0.59 · graph-inferred
If reviewed: Galantamine; medicines 7 → 5; anticholinergic burden 7 → 4; fall-risk drugs 6 → 4.
Question 2
Could the dizziness be from the alpha blocker (often on standing)? Vestibular sedatives are strongly anticholinergic and add fall risk.
- Tamsulosin (Apr 21, 2025) → dizziness or spinning → Dimenhydrinate (May 23, 2025) · likely 0.99 · consensus
- Dimenhydrinate (May 23, 2025) → confusion or memory problems → Donepezil (Jun 29, 2025) · likely 0.59 · graph-inferred
- Donepezil (Jun 29, 2025) → diarrhoea → Loperamide (Jul 18, 2025) · likely 0.59 · graph-inferred
If reviewed: Dimenhydrinate; medicines 7 → 5; anticholinergic burden 7 → 4; fall-risk drugs 6 → 4.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Oxybutynin as prescribed Dr. M. Fischer (urology) | Apr 20, 2025 | Urinary incontinence | Root of a cascade ACB +3 Beers-listed |
| Tamsulosin as prescribed Dr. H. Singh (family doctor) | Apr 21, 2025 | Enlarged prostate (BPH) | Root of a cascade |
| Dimenhydrinate as prescribed Dr. R. Ahmed (walk-in clinic) | May 23, 2025 | Dizziness / vertigo | Possibly treating a side effect ACB +3 Beers-listed |
| Donepezil as prescribed Dr. R. Ahmed (walk-in clinic) | Jun 29, 2025 | — | Possibly treating a side effect |
| Loperamide as prescribed Dr. T. Nguyen (walk-in clinic) | Jul 18, 2025 | — | Possibly treating a side effect ACB +1 |
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.