Pharmacology reference by Michael L. Iczkovitz, D. D. S



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Use: Treatment of idiopathic, symptomatic or postencephalitic Parkinsonism.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, bitter taste, headache, paresthesia, orthostatic hypotension and blood dyscrasias.

Dental Drug Interactions: Decreases effects of benzodiazepines.



Pergolide Mesylate (Permax)

Action: Semisynthetic ergot alkaloid, centrally acting dopamine agonist.

Use: Adjunct to Levodopa and Carbidopa to manage Parkinson’s disease.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Postural

hypotension, chills, dry mouth.



Dental Drug Interactions: None.


Anti-Parkinson Agent


Pramipexole (Mirapex)

Action: Pre- and postsynaptic dopamine agonist.

Use: Treat signs and symptoms of Parkinson’s Disease.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Postural

hypotension, hyperesthesia, and dry mouth.



Dental Drug Interactions: None
Selegiline (Eldepryl)

Action: MAO inhibitor, MAO causes dopamine metabolism. May also interfere with

dopamine reuptake.



Use: Treat Parkinson patients where levodopa/carbidopa not working.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth and

orthostatic hypotension.



Dental Drug Interactions: Don’t use with Demerol, serotonin syndrome.

Benztropine (Cogentin)

Action: Blocks central acetylcholine receptors. Helps balance cholinergic and dopaminergic activity.

Use: Treat Parkinson symptoms and extrapyramidal symptoms associated with neuroleptic drugs.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, nose and throat, glossitis. Sometimes increased salivation.

Dental Considerations: Headache, difficulty swallowing, photophobia, orthostatic hypotension and elevated temperature.

Dental Drug Interactions: Increased anticholinergic effects with antihistamines, meperidine and other anticholinergics. Increased CNS depression with alcohol and other CNS depressants.


Rivastigmine (Exelon)

Action: Reversible inhibition of hydrolysis of cholinesterase, increases

acetylcholinesterase concentration in the CNS.



Use: Dementia due to Alzheimer’s disease.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache,

pharyngitis, Stevens-Johnson syndrome.



Dental Drug Interactions: May increase risk of ulcers with NSAIDs. Reduces effects

of anticholinergics. Increases effects of cholinergics


Ropinirole (ReQuip)

Action: Dopamine receptor agonist in the brain.

Use: Parkinson’s disease.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth,

headache, postural hypotension, blood dyscrasias, pharyngitis.



Dental Drug Interactions: Increased sedation with other CNS depressants.

Anti-Parkinson Agent


Amantadine (Cyclocort)

Action: Works as antiviral by uncoating of influenza A virus to prevent penetration into

host, as antiParkinson by blocking dopamine reuptake and stimulation of postsynaptic

neurons.

Use: Treat Parkinson’s disease, influenza A virus, and drug induced extrapyramidal

symptoms.



Dental Consideration: Local anesthesia with vasoconstrictor ok. Dry mouth,

orthostatic hypotension, headache, blood dyscrasias.



Dental Drug Interactions: Anticholinergics increase CNS side effects of amantadine.

Anti-Migraine Agent

  • Serotonin Agonist

Action: Selective agonist for serotonin receptor in cranial arteries causing vasodilatation with little or no effect on peripheral pressure.

Use: Acute treatment of migraine headaches with or without aura. Also to treat cluster headaches.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Mouth, jaw, tongue, throat and sinus discomfort.

Dental Considerations: Headache, photophobia and myalgia. Paresthesia with tingling, hot or burning sensation, numbness.

Dental Drug Interactions: None

Sumatriptan (Imitrex)


Zomitriptan (Zomig)

Rizatriptan (Maxalt)


Naratriptan (Amerge)

Thyroid Hormone

Action: Stimulates protein synthesis, increases basal metabolic rate, utilization glucose and growth.

Use: Hypothyroid, myxedema coma, thyroid hormone replacement and cretinism.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache, myalgia and fever.

Dental Drug Interactions: Increases effect of oral anticoagulants.

Levothyroxine, T 4, (Synthroid, Levoxyl)

Liotrix, T 4 & T 3, (Euthroid, Thyrolar)


Liothyronine, T 3, (Cytomel, Triostat)

Gastric Acid Secretion Inhibitors

Action: Inhibits histamine at H-2 receptor sites of gastric parietal cells, decreased gastric acid secretion.

Use: Treat and prophylaxis of duodenal and gastric ulcers, treat gastroesophageal reflux, upper GI bleed, hypersecretory conditions, stress ulcers, GI symptoms secondary to NSAIDs.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache, arthralgia, blood dyscrasias, angioneurotic edema and fever.

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