Medication review brief · for the pharmacist
Harold Wong
66 · male · Hypertension, Hypothyroidism, Type 2 diabetes, Osteoarthritis pain, High cholesterol, Enlarged prostate (BPH)
Prepared by Domino · Oct 1, 2026
Summary
2 likely prescribing cascade links. If Tramadol were reviewed, up to 1 downstream medicine might no longer be needed (8 → 6). Anticholinergic burden is 3.
Question 1
Could dizziness or spinning be from Tramadol?
- Tramadol (Jul 19, 2023) → dizziness or spinning → Meclizine (Jul 25, 2023) · likely 0.74 · graph-inferred
If reviewed: Polyethylene glycol (planned companion); medicines 8 → 6; anticholinergic burden 3 → 3; fall-risk drugs 5 → 4.
Do not stop abruptly
- Tramadol: Taper if changed: stopping suddenly causes withdrawal.
Question 2
Could the dizziness be from the alpha blocker (often on standing)? Vestibular sedatives are strongly anticholinergic and add fall risk.
- Tamsulosin (Jul 9, 2023) → dizziness or spinning → Meclizine (Jul 25, 2023) · likely 0.99 · consensus
If reviewed: no downstream change; medicines 8 → 7; anticholinergic burden 3 → 3; fall-risk drugs 5 → 4.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Glipizide as prescribed Dr. H. Singh (family doctor) | Apr 8, 2023 | Type 2 diabetes | Beers-listed |
| Tamsulosin as prescribed Dr. H. Singh (family doctor) | Jul 9, 2023 | — | Root of a cascade |
| Tramadol as prescribed Dr. C. Laurent (rheumatology) | Jul 19, 2023 | Osteoarthritis pain | Root of a cascade Beers-listed |
| Polyethylene glycol as prescribed Dr. C. Laurent (rheumatology) | Jul 19, 2023 | Constipation | |
| Meclizine as prescribed Dr. R. Ahmed (walk-in clinic) | Jul 25, 2023 | Dizziness / vertigo | Possibly treating a side effect ACB +3 Beers-listed |
| Levothyroxine |
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.