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



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Dental Drug Interactions: Decreased absorption of ketoconazole, itraconazole and valium, increased toxicity of versed. Variable effects on warfarin.

Ranitidine (Zantac)

Cimetidine (Tagamet) Decreases tetracycline absorption, increases blood levels alcohol, diazepam and narcotic analgesics.

Nizatidine (Axid) #92 in 97’

Famotidine (Pepcid) #50 in 97’ Dry mouth, taste changes, paresthesia, tinnitus, myalgia




Action: Gastric parietal cell pump inhibited less gastric acid secretion.

Use: Treat peptic and gastric ulcer disease, severe erosive esophagitis, gastroesophageal reflux disease, hypersecretory conditions and NSAID induced ulcers.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache, dry mouth, taste alterations, mucosal atrophy of tongue, candidiasis, tinnitus, myalgia, arthralgia and fever.

Dental Drug Interactions: Decreased effect of ketoconazole and itraconazole, increased effect of valium, coumadin.

Omeprazole (Prilosec)

Lansoprazole (Prevacid)


Rabeprazole (Aciphex) facial edema, gingivitis, glossitis, paresthesia, photosensitivity, salivary gland enlargement

Pantoprazole (Protonix)

Esomeprazole (Nexium)

Anti-Inflammatory Agent

Sulfasalazine (Azulfidine)

Action: Sulfasalazine has high affinity for connective tissue and serous fluid, liver and intestinal walls. The principle metabolites of this sulfonamide derivative are sulfapyridine and 5-aminosalicyclic acid (the anti-inflammatory agent).


Use: Treat ulcerative colitis, Crohn’s disease and rheumatoid arthritis.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache, fever, chills, Stevens-Johnson syndrome, blood dyscrasias.

Anti-Inflammatory Agent

Sulfasalazine (Azulfidine) (continued)

Dental Drug Interactions: Decreases effect of oral anticoagulants, ester type local anesthetics (procaine, tetracaine) and penicillins and cephalosporins. Increases tetracycline photosensitizing effect.



Mesalamine (Asacol, Pentasa, Rowasa)

Action: 5-aminosalicyclic acid, works topically to modulate chemical mediators of

inflammation.



Use: Treat ulcerative colitis, proctosigmoiditis, and proctosis.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache, blood

dyscrasias.



Dental Drug Interactions: None

GI Anticholinergic

Action: Blocks action of acetycholine at parasympathetic sites in smooth muscle, secretory glands and the CNS. Functions as GI antispasmodic agent.

Use: Treat irritable bowel syndrome, urinary incontinence, infant colic, in combination with other drugs for peptic ulcer disease.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, throat and nose, headache, dysphagia, photophobia, fever and orthostatic hypotension.

Dental Drug Interactions: Increases toxicity of narcotics, antihistamines, other anticholinergics. Decreases effects of ketoconazole.

Dicyclomine (Bentyl, Antispas)

Clidinium** and Chlordiazepoxide* (Librax) *Is the benzodiazepine Librium **Taste alterations


Hyoscyamine (Levbid)
Cholinergic

Action: Inhibits destruction of acetylcholine thus increasing acetylcholine concentration.

Use: Nondepolarizing muscle relaxant antagonist, myasthenia gravis.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Salivation, tongue

weakness, headache, bronchospasm and laryngospasm.



Dental Drug Interactions: Decreases effects of anticholinergics. Reduces rate of

metabolism of ester local anesthetics.



Pyridostigmine (Mestinon)
Monoclonal Antibody

Action: Binds to an inflammatory cytokine.

Use: Treat rheumatoid arthritis and Crohn’s disease.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Candidiasis,

headache, fever, TMJ-myalgia, pharyngitis, sinusitis.



Dental Drug Interactions: None

Infliximab ( Remicade)

Anti-Emetic

Metoclopramide (Reglan)

Action: Blocks dopamine receptors in chemoreceptor trigger zone of CNS.

Enhances response to acetylcholine in upper GI tract enhancing motility and gastric emptying without simultaneous gastric, biliary or pancreatic secretion.

Use: Treat diabetic gastric stasis, gastroesophageal reflux, prevent nausea from chemotherapy, radiation and post surgery.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, headache and blood dyscrasias.

Dental Drug Interactions: Decreased GI action with anticholinergics, opiods. Increased sedation with alcohol and other CNS depressants.




Dronabinol (Marinol)

Action: Probably inhibits vomiting center in medulla oblongata

Use: When conventional antiemetics fail to relieve nausea and vomiting associated with cancer chemotherapy, AIDs related anorexia


Dental Considerations: Local anesthesia with vasoconstrictor ok. Orthostatic

hypotension, headache, dry mouth, paresthesia, myalgia and tinnitus.



Dental Drug Interactions: Increased drowsiness with alcohol, barbiturates and

benzodiazepines.



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