George Bergeron

75 · male · Type 2 diabetes, Coronary artery disease, Enlarged prostate (BPH)

Prepared by Domino · Oct 1, 2026

Summary

1 likely prescribing cascade link. If Tamsulosin were reviewed, up to 1 downstream medicine might no longer be needed (5 → 3). Anticholinergic burden is 3.

Question 1

Could the dizziness be from the alpha blocker (often on standing)? Vestibular sedatives are strongly anticholinergic and add fall risk.

Tamsulosin (Dec 25, 2022) → dizziness or spinning → Dimenhydrinate (Feb 12, 2023) · likely 0.99 · consensus

If reviewed: Dimenhydrinate; medicines 5 → 3; anticholinergic burden 3 → 0; fall-risk drugs 2 → 0.

Medicines

Medicine	Started	Charted for	Domino
Tamsulosin as prescribed Dr. J. Martin (family doctor)	Dec 25, 2022	Enlarged prostate (BPH)	Root of a cascade
Dimenhydrinate as prescribed Dr. R. Ahmed (walk-in clinic)	Feb 12, 2023	Dizziness / vertigo	Possibly treating a side effect ACB +3 Beers-listed
Metformin as prescribed Dr. J. Martin (family doctor)	Nov 26, 2023	Type 2 diabetes
Aspirin (low dose) as prescribed Dr. J. Martin (family doctor)	Dec 5, 2023	Coronary artery disease	Beers-listed
Omeprazole as prescribed Dr. J. Martin (family doctor)	Dec 6, 2023	GI bleeding risk	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.
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.