Clinically Significant Drug-Drug Interactions in Dentistry

TABLE 4 Clinically Significant ug—Drug Interac ns in Dentistry SYMPATHOMIMETICS (CONTAINED IN LOCAL ANESTHETICS) DRUG INTERACTING DRUG EFFECT WHAT TO DO? Epinephrine Beta-blockers Elevate blood pressure Epinephrine should be used Nonselective (31,82) such as cautiously. Limit the amount used propranolol (Inderal). nadolol 10 0-04 mg (‘WO cartridges 0f (Corgard). timolol (Blocad» l:l00,000). ren). and sotalol (Betapace) Selective beta-blockers ([3]) No elevation in blood pressure No concerns such as alenolol (Tenormiu). metoprolol (Lopressor). acer butolol (Sectral). and belaxolol (Kerlone) Tricyclic antidepressants Hypertension (enhances sym» Treat similar to the cardiac patient: pathomimetic effects) maximum amount is two carlridges of EPI 1:100,000. Cocaine Increase heart contraction lead- Do not use epinephrine if the patient ing to death used cocaine within 24 hours. Levonordefrin Nonselcctive beta—blockers (eg. Stimulate alphaercceptors Minimize the amount of (contained in propranolol, nadolol) on hean tissue. causing an levonordefrin. mepivicaine) increase in blood pressure: Tricyclic antidepressants (e.g., ‘ ' ' milriptyline) limit use of vasoconstrictor Enhance sympathornimetic effects Avoid use of levonordefn'n.