Ruth Murphy

87 · female · Gout / hyperuricaemia, Hypertension, Neuropathic pain, High cholesterol, Anxiety

Medicines

Likely cascade links

Could be avoidable

Anticholinergic burden

Drugs toward falls

Dangerous combos

Root drug · likely · score 0.99

Hydrochlorothiazide → 2 downstream

Hydrochlorothiazide

Thiazide diuretic

Allopurinol

Urate-lowering therapy

Solifenacin

Urinary antimuscarinic

Why Domino thinks so

Hydrochlorothiazide started Nov 13, 2022 · Allopurinol started Oct 30, 2023

0.99

likely

How often it causes this×0.7Gout / hyperuricaemia is common with Hydrochlorothiazide.

Timing×1Allopurinol started 12 months after Hydrochlorothiazide, inside the usual window for gout / hyperuricaemia (30 to 365 days).

Other reasons×1.25Allopurinol was charted for gout / hyperuricaemia.

Published evidence×1.15Matches a documented cascade backed by a published study.

Thiazide → gout → gout treatment

Evidence: published study

Rochon PA, Gurwitz JH. The prescribing cascade revisited. Lancet. 2017;389(10081):1778-1780.

Question for the pharmacist: Could the gout be from the diuretic raising uric acid? A different antihypertensive may be an option.

Teach Domino. Your decision becomes memory every future review respects.

Checked and set aside

Analysis: 10 FalkorDB queries, run in parallel, 92 ms