Edward Reid

70 · male · Hypertension, Hypothyroidism, Coronary artery disease, High cholesterol, Enlarged prostate (BPH), Depression

Pharmacist brief Check a new prescription Export FHIR

Medicines

Likely cascade links

Could be avoidable

Anticholinergic burden

Drugs toward falls

Dangerous combos

Root drug · likely · score 0.99

Tamsulosin → 1 downstream

Tamsulosin

Alpha-1 blocker

Meclizine

Vestibular sedative

Root drug · possible · score 0.34

Atorvastatin → 1 downstream

Atorvastatin

Statin

Sitagliptin

DPP-4 inhibitor

Why Domino thinks so

Tamsulosin → dizziness or spinning → Meclizine

Tamsulosin started May 23, 2025 · Meclizine started Jun 26, 2025

0.99

likely

How often it causes this×0.7Dizziness / vertigo is common with Tamsulosin.

Timing×1Meclizine started 5 weeks after Tamsulosin, inside the usual window for dizziness / vertigo (1 to 60 days).

Other reasons×1.25Meclizine was charted for dizziness / vertigo.

Published evidence×1.2Matches a documented cascade backed by expert consensus (ThinkCascades).

Alpha-1 blocker → dizziness → vestibular sedative

Evidence: expert consensus

Real-world signal: adjusted sequence ratio 1.63 (95% CI 1.46–1.81), found in 3% of Ireland, 533,464 adults aged 65+.

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

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

Checked and set aside

Analysis: 10 FalkorDB queries, run in parallel, 18 ms