Action: Increases release of norepinephrine and dopamine in the cerebral cortex to the reticular activating system. Stimulates cerebral cortex and subcortical structures similar to amphetamines.
Use: Treat attention deficit disorder with hyperactivity, narcolepsy.
Dental Considerations: Local anesthesia with vasoconstrictor ok unless patient is hypertensive. Dry mouth, headache, blood dyscrasias, and erythema multiforme.
Dental Drug Interactions: May increase effects of oral anticoagulants and barbiturates.
Action: Blocks reuptake of dopamine, acts at cerebral cortex and subcortical
Use: Attention deficit disorder with hyperactivity, narcolepsy.
Dental Considerations: Local anesthesia with vasoconstrictor ok..
Dental Drug Interactions: None
Action: CNS stimulant, mechanism of action unknown.
Dental Considerations: Local anesthesia with vasoconstrictor ok. Chills, fever, dry
mouth, oral ulcerations, gingivitis, blood dyscrasias, arthralgia, paresthesia, pharyngitis,
Dental Drug Interactions: May increase coumadin toxicity. Azole antifungals,
ketoconazole and itraconazole may increase toxicity of modafinil. May increase
Dextroamphetamine and Amphetamine (Adderall)
Dextroamphetamine (Dexedrine, Dextrostat)
Action: Blocks dopamine and norepinephrine reuptake, increasing their concentration in
cerebral cortex and reticular activating system. MAO inhibitor, causes catecholamine
Use: Treat narcolepsy, obesity, abnormal behavior syndrome in children, attention
Dental Considerations: No local anesthetic with vasoconstrictor, potential hypertension
and cardiotoxicity. Headache, dry mouth, unpleasant taste.
Dental Drug Interactions: Arrhythmias possible with general anesthetics.
Action: Reversible inhibitor of lipases, prevents GI absorption of fats.
Use: Treat obesity.
Dental Considerations: Local anesthesia with vasoconstrictor ok. Gingival and tooth
disorder, headache, TMJ-myalgia, TMJ-arthralgia.
Dental Drug Interactions: Decreases vitamin K absorption, makes warfarin more
Ergoloid Mesylates (Germinal, Hydergine)
Action: May increase cerebral blood flow and metabolism.
Use: Treatment of cerebrovascular insufficiency in primary progressive dementia, Alzheimer’s dementia, multiinfarct dementia and senile dementia.
Dental Considerations: Local anesthesia with vasoconstrictor ok. Sublingual irritation, orthostatic hypotension, headache.
Dental Drug Interactions: None
Ergotamine (Cafergot, Wigraine) Adrenergic blocking agent, prevent vascular headaches, such as migraine or cluster. Dry mouth, myalgia and paresthesia. Macrolide antibiotics may cause ergot toxicity.
Action: Central acting reversible cholinesterase inhibitor, increases acetylcholine
Use: Treat mild to moderate dementia associated with Alzheimer’s disease.
Dental Considerations: Local anesthesia with vasoconstrictor ok. Toothache, dry
mouth, bad taste, gingivitis, tongue edema, coated tongue, headache, muscle
cramps, arthritis, blood dyscrasias, tinnitus.
Dental Drug Interactions: Use with NSAIDs increases risk GI bleeds. Action
decreased by anticholinergics, increases action of succinylcholine. Ketoconazole may
inhibit drugs metabolism.
Action: Unknown, possible reversible inhibition of acetylcholinesterase.
Use: Alzheimer’s disease.
Dental Considerations: Local anesthesia with vasoconstrictor ok. Postural
hypotension, paresthesia, dysphagia, dry mouth, blood dyscrasias.
Dental Drug Interactions: Increases activity of succinylcholine, cholinergic agonists
like bethanechol. Ketoconazole and erythromycin increases Galantamine
Valproic Acid and Derivatives (Depacon, Depakene, Depakote)
Action: Increases levels of gamma aminobutyric acid, an inhibitory neurotransmitter, in the brain.
Use: Simple, complex (petit mal) absence, mixed seizures, complex partial seizures, migraine prophylaxis, tonic-clonic (grand mal) seizures and infantile spasms. Depakote for manic episodes in bipolar disorder.
Dental Considerations: Local anesthesia with vasoconstrictor ok. Gingival enlargements, headache, erythema multiforme, blood dyscrasias with prolonged bleeding and delayed healing.
Dental Drug Interactions: Increases toxicity of barbiturates, alcohol and CNS depressants potentiates depressant effects of valproic acid. Increases bleeding with aspirin, NSAIDs and coumadin.
Action: Inhibits nerve impulses by limiting influx of sodium ions across cell membrane in motor cortex. Also has anticholinergic, antineuralgic, antidiuretic, muscle relaxant and antiarrhythmic properties.