Ruth Murphy

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

Prepared by Domino · Oct 1, 2026

Summary

1 likely prescribing cascade link. If Hydrochlorothiazide were reviewed, up to 2 downstream medicines might no longer be needed (6 → 3). Anticholinergic burden is 3.

Question 1

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

Hydrochlorothiazide (Nov 13, 2022) → gout or high uric acid → Allopurinol (Oct 30, 2023) · likely 0.99 · study
Hydrochlorothiazide (Nov 13, 2022) → leaking urine, urgency → Solifenacin (Dec 14, 2022) · possible 0.48 · consensus

If reviewed: Solifenacin, Allopurinol; medicines 6 → 3; anticholinergic burden 3 → 0; fall-risk drugs 4 → 2.

Medicines

Medicine	Started	Charted for	Domino
Hydrochlorothiazide as prescribed Dr. A. Patel (family doctor)	Nov 13, 2022	Hypertension	Root of a cascade Beers-listed
Solifenacin as prescribed Dr. R. Ahmed (walk-in clinic)	Dec 14, 2022	—	Possibly treating a side effect ACB +3 Beers-listed
Duloxetine as prescribed Dr. A. Patel (family doctor)	Dec 25, 2022	Neuropathic pain	Beers-listed
Atorvastatin as prescribed Dr. A. Patel (family doctor)	May 25, 2023	—
Allopurinol as prescribed Dr. A. Patel (family doctor)	Oct 30, 2023	Gout / hyperuricaemia	Possibly treating a side effect
Lorazepam as prescribed Dr. A. Patel (family doctor)	May 9, 2026	Anxiety	Beers-listed

Evidence

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