Medication review brief · for the pharmacist
Edward Reid
70 · male · Hypertension, Hypothyroidism, Coronary artery disease, High cholesterol, Enlarged prostate (BPH), Depression
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 (8 → 6). Dangerous combination: bleeding stack. 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 (May 23, 2025) → dizziness or spinning → Meclizine (Jun 26, 2025) · likely 0.99 · consensus
If reviewed: Meclizine; medicines 8 → 6; anticholinergic burden 3 → 0; fall-risk drugs 4 → 2.
Question 2
Could high blood sugar be from Atorvastatin?
- Atorvastatin (Mar 6, 2026) → high blood sugar → Sitagliptin (Aug 16, 2026) · possible 0.34 · graph-inferred
If reviewed: Sitagliptin; medicines 8 → 6; anticholinergic burden 3 → 3; fall-risk drugs 4 → 4.
Combinations
- Bleeding stack (Aspirin (low dose) + Sertraline): An anticoagulant or antiplatelet combined with an NSAID or SSRI/SNRI raises bleeding risk.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Lisinopril as prescribed Dr. A. Patel (family doctor) | Apr 23, 2023 | Hypertension | |
| Aspirin (low dose) as prescribed Dr. A. Patel (family doctor) | Nov 29, 2023 | Coronary artery disease | Beers-listed |
| Levothyroxine as prescribed Dr. A. Patel (family doctor) | Oct 8, 2024 | Hypothyroidism | |
| Tamsulosin as prescribed Dr. A. Patel (family doctor) | May 23, 2025 | Enlarged prostate (BPH) | Root of a cascade |
| Sertraline as prescribed Dr. A. Patel (family doctor) | Jun 12, 2025 | Depression | Beers-listed |
| Meclizine as prescribed Dr. R. Ahmed (walk-in clinic) | Jun 26, 2025 |
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.
- American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081.
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.