Medication review brief · for the pharmacist
Kenji Li
85 · male · Hypertension, Type 2 diabetes, Heart failure, Enlarged prostate (BPH)
Prepared by Domino · Oct 1, 2026
Summary
1 likely prescribing cascade link. If Doxazosin were reviewed, up to 1 downstream medicine might no longer be needed (5 → 3). Anticholinergic burden is 4.
Question 1
Could the dizziness be from the alpha blocker (often on standing)? Vestibular sedatives are strongly anticholinergic and add fall risk.
- Doxazosin (Jan 15, 2024) → dizziness or spinning → Dimenhydrinate (Mar 4, 2024) · likely 0.99 · consensus
If reviewed: Dimenhydrinate; medicines 5 → 3; anticholinergic burden 4 → 1; fall-risk drugs 5 → 3.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Furosemide as prescribed Dr. K. Osei (cardiology) | Oct 17, 2022 | Heart failure | ACB +1 Beers-listed |
| Doxazosin as prescribed Dr. J. Martin (family doctor) | Jan 15, 2024 | — | Root of a cascade Beers-listed |
| Dimenhydrinate as prescribed Dr. J. Martin (family doctor) | Mar 4, 2024 | Dizziness / vertigo | Possibly treating a side effect ACB +3 Beers-listed |
| Glipizide as prescribed Dr. J. Martin (family doctor) | Jan 17, 2025 | Type 2 diabetes | Beers-listed |
| Amlodipine as prescribed Dr. J. Martin (family doctor) | Feb 6, 2026 | Hypertension |
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.