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

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Dental Considerations: Local anesthesia with vasoconstrictor ok. Metallic taste, dry mouth, blood dyscrasias, paresthesia, fever, paresthesia, tinnitus and Stevens-Johnson syndrome.

Dental Drug Interactions: Toxicity with large dose salicylates. Hypokalemia with corticosteroids.

Acetazolamide (Diamox)

Dorzolamide (Trusopt) Eye drops, only to treat glaucoma. Photophobia.

Methazolamide (GlaucTabs)

Antiglaucoma Agent

  • Cholinergic (Parasympathetic) Agent

Action: Directly stimulates cholinergic receptors in the eye causing miosis (contraction of iris sphincter). Also causes loss of accommodation and lowering of intraocular pressure by decreasing resistance to aqueous humor outflow.

Use: Management of chronic simple glaucoma, chronic and acute angle closure glaucoma, counter effects of mydriatics.

Dental Considerations: Local anesthesia with vasoconstrictors ok. Headache, photophobia, excessive salivation.

Dental Drug Interactions: May antagonize effects of anticholinergics.

Pilocarpine (Isopto)

  • Prostaglandin Analogue

Action: Reduces intraocular pressure by increasing uveoscleral outflow of aqueous humor.

Use: Open angle glaucoma and ocular hypertension in patients intolerant to other intraocular pressure lowering drugs.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Myalgia, arthralgia and photophobia.

Dental Drug Interactions: Avoid anticholinergics.

Latanoprost (Xalatan) Eye drops.

  • Alpha 2 Adrenergic Agonist

Action: Selects alpha-2 receptors, reduces aqueous humor formation and increases

uveoscleral outflow.

Use: Lower intraocular pressure with open-angle glaucoma or ocular hypertension.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache,

xerostomia and photophobia.

Dental Drug Interactions: Increases CNS depressant effects.

Brimonidine (Alphagan)

Antispasmodic Agent

  • Urinary

Action: Inhibits action of acetylcholine on smooth muscle, no effect at skeletal muscle or autonomic ganglia. Increases bladder capacity, decreases uninhibited bladder contractions.

Use: Treat neurogenic bladder (problems with urgency, frequency, urge incontinence) and uninhibited bladder.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Significant dry mouth, headache, and fever.

Dental Drug Interactions: Increased anticholinergic effect with antihistamines and anticholinergics. Additive sedation with CNS depressants.

Oxybutynin (Ditropan)

Antispasmodic Agent

  • Urinary (continued)

Flavoxate (Urispas) Also treat dysuria, nocturia and suprapubic pain. Dry throat, blood dyscrasias.


Action: Completely blocks the action of acetylcholine at postganglionic parasympathetic receptor sites.

Use: Treat peptic ulcer disease, irritable bowel syndrome, pancreatitis, duodenography, urinary incontinence, ureter and urinary bladder spasm, induce dry field in oral cavity.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, absence of taste, headache, dysphagia, photophobia and fever. Avoid in pregnancy, ok with lactation.

Medical Considerations: >10%; constipation, decreased sweating. 1-10%; dysphagia.

Medical Considerations: Other adverse reactions; insomnia, dizziness, drowsiness, anxiety, weakness, hallucinations, palpitations, tachycardia, paralytic ileus, heartburn, nausea, vomiting, hesitancy, retention, impotence, blurred vision, mydriasis, cycloplegia, increased ocular tension, urticaria, rash, pruritis, and allergic reactions.

Contraindications: Narrow angle glaucoma, ulcerative colitis, toxic megacolon, obstructive disease of GI or urinary tract, myasthenia gravis.

Precautions: Hyperthyroid, hepatic, cardiac, endocrine or renal disease, hypertension, GI disease, hiatal hernia and prostatic hypertrophy.

Dental Drug Interactions: Increases anticholinergic effects other anticholinergic drugs, narcotics. Constipation, urinary retention with opioid analgesics.

Dental Drug Interactions: Decreased absorption of ketoconazole. Corticosteroids increase intraocular pressure. Increased sedation with CNS depressants.

Medical Drug Interactions: Increased anticholinergic effect with antiarrhythmic agents, antihistamines, phenothiazines, TCAs, beta-blockers. Decreased absorption with antacids.

Propantheline (Pro-Banthine)

  • Tolterodine (Detrol)

Action: Muscurinic receptor antagonist more specific for urinary bladder than salivary


Use: Treat overactive bladder with symptoms of urinary frequency, urgency or urge


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

paresthesia, pharyngitis, sinusitis and arthralgia.

Dental Drug Interactions: None

Urinary Analgesic

Action: An azo dye, which exerts a local anesthetic effect on the urinary tract.

Use: Symptomatic relief of urinary burning, itching, frequency and urgency associated with urinary tract infection or following urology procedures.

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