Medication review brief · for the pharmacist
George Reid
83 · male · Urinary incontinence, Hypertension, Osteoarthritis pain, Enlarged prostate (BPH)
Prepared by Domino · Oct 1, 2026
Summary
2 likely prescribing cascade links. If Diclofenac were reviewed, up to 2 downstream medicines might no longer be needed (5 → 2). Anticholinergic burden is 3.
Question 1
Could the raised blood pressure be from the NSAID? NSAIDs raise blood pressure and blunt most antihypertensives.
- Diclofenac (Apr 8, 2023) → high blood pressure → Hydrochlorothiazide (Jun 6, 2023) · likely 0.99 · consensus
- Hydrochlorothiazide (Jun 6, 2023) → gout or high uric acid → Allopurinol (Dec 2, 2023) · likely 0.81 · study
If reviewed: Hydrochlorothiazide, Allopurinol; medicines 5 → 2; anticholinergic burden 3 → 3; fall-risk drugs 3 → 2.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Diclofenac as prescribed Dr. A. Patel (family doctor) | Apr 8, 2023 | — | Root of a cascade Beers-listed |
| Hydrochlorothiazide as prescribed Dr. A. Patel (family doctor) | Jun 6, 2023 | Hypertension | Possibly treating a side effect Beers-listed |
| Allopurinol as prescribed Dr. A. Patel (family doctor) | Dec 2, 2023 | — | Possibly treating a side effect |
| Doxazosin as prescribed Dr. A. Patel (family doctor) | Apr 12, 2024 | Enlarged prostate (BPH) | Beers-listed |
| Solifenacin as prescribed Dr. A. Patel (family doctor) | Dec 15, 2024 | Urinary incontinence | ACB +3 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.
- Gurwitz JH, et al. Initiation of antihypertensive treatment during nonsteroidal anti-inflammatory drug therapy. JAMA. 1994;272(10):781-786.
- 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.
- Rochon PA, Gurwitz JH. The prescribing cascade revisited. Lancet. 2017;389(10081):1778-1780.
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.