Gerald Hughes

66 · male · Hypertension, Reflux / indigestion, Enlarged prostate (BPH), Depression

Prepared by Domino · Oct 1, 2026

Summary

2 likely prescribing cascade links. If Tamsulosin were reviewed, up to 2 downstream medicines might no longer be needed (6 → 3). 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 (Sep 17, 2023) → dizziness or spinning → Meclizine (Oct 3, 2023) · likely 0.99 · consensus
Meclizine (Oct 3, 2023) → confusion or memory problems → Donepezil (Oct 17, 2023) · likely 0.59 · graph-inferred

If reviewed: Meclizine, Donepezil; medicines 6 → 3; anticholinergic burden 3 → 0; fall-risk drugs 5 → 2.

Medicines

Medicine	Started	Charted for	Domino
Tamsulosin as prescribed Dr. M. Fischer (urology)	Sep 17, 2023	—	Root of a cascade
Meclizine as prescribed Dr. H. Singh (family doctor)	Oct 3, 2023	Dizziness / vertigo	Possibly treating a side effect ACB +3 Beers-listed
Donepezil as prescribed Dr. H. Singh (family doctor)	Oct 17, 2023	—	Possibly treating a side effect
Sertraline as prescribed Dr. H. Singh (family doctor)	May 11, 2024	Depression	Beers-listed
Lisinopril as prescribed Dr. H. Singh (family doctor)	Nov 15, 2024	Hypertension
Pantoprazole as prescribed Dr. H. Singh (family doctor)	Dec 15, 2024	Reflux / indigestion	Beers-listed

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.