Metoprolol (Lopressor, Toprol)
Action: Blocks alpha 1 receptors present in vascular smooth muscle resulting in peripheral vasodilatation and a decrease in blood pressure. Also relaxes smooth muscle of bladder neck reducing bladder outlet obstruction.
Use: Treat mild to moderate hypertension, benign prostatic hypertrophy, Raynauds Syndrome.
Local anesthesia with vasoconstrictor ok. Dry mouth, orthostatic hypotension, headache, tinnitus and sinusitis.
Dental Drug Interactions:
NSAIDs, Indomethacin decreases effects of alpha 1 peripheral blockers.
Adrenergic Inhibitors +
Alpha 1 Peripheral Blocker* and Thiazide Diuretic**
Hydroflumethiazide** and Reserpine* (Salutensin)
Action: **Produces diuresis, *depletes sympathetic amines (norepinephrine and
dopamine) to reduce blood pressure.
Use: Management of hypertension
Dental Considerations: Local anesthesia with vasoconstrictor ok. Blood dyscrasias,
photosensitivity, paresthesia, dry mouth and headache.
Dental Drug Interactions: NSAID decrease hypotensive response, Tetracycline
Noncardioselective Beta-Blocker and Alpha-Blocker
Labetalol (Normodyne, Trandate)
Action: Blocks beta-1, beta-2 and alpha-receptors, reduces rennin levels.
Use: Mild to severe hypertension
Dental Considerations: Noncardioselective beta-blockers mixed with vasoconstrictor in
local anesthesia, epinephrine, may cause initial hypertension followed by bradycardia. Dry mouth, altered taste, lichenoid reaction, headache, paresthesia, orthostatic hypotension, blood dyscrasias, tinnitus, sore throat, fever, arthralgia.
Dental Drug Interactions: Decreases metabolism of lidocaine. NSAIDs decrease
medications hypotensive effects, less than three-day use ok. Barbiturates decrease
hypotensive effects also. Hydrocarbon inhalation general anesthetics increase
hypotension and cardiac depression.
Central Acting Alpha 2 Agonists
Action: Stimulates alpha 2 receptors in brain stem. Reduces sympathetic outflow, decreases blood pressure, pulse rate and cardiac output. Peripheral vasodilatation.
Use: Treat mild to moderate hypertension, heroin withdrawal and smoking cessation, migraine prophylaxis, glaucoma, paralytic ileus and diabetic diarrhea.
Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, orthostatic hypotension, headache, blood dyscrasias.
Dental Drug Interactions: Increased sedation with alcohol and all CNS depressants.
Adrenergic Inhibitor +
*Beta Blocker and **Diuretic
Action: Beta 1 blocker reduces cardiac output. Thiazide diuretic increases renal excretion of water, sodium, chloride, potassium and hydrogen ions.
Use: Treatment of hypertension.
Dental Considerations: Local anesthesia with vasoconstrictor ok with cardioselective, not with noncardioselective. Headache, arthralgia, myalgia, blood dyscrasias, dry mouth, photosensitivity and orthostatic hypotension
Dental Drug Interactions: Don’t use NSAIDs longer 3 days, reduces hypotensive effect, Tetracycline increases photosensitivity.
*Bisoprolol and **Hydrochlorothiazide (Ziac) *Cardioselective, sore throat
*Propranolol and **Hydrochlorothiazide (Inderide) *Noncardioselective, paresthesia.
Action: Direct vasodilatation of arterioles (with little effect on veins), decreases systemic resistance. Decreases blood pressure, reflex increases cardiac function.
Use: Treat moderate to severe hypertension, congestive heart failure, hypertension secondary to eclampsia and primary pulmonary hypertension.
Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache, flushing of face, blood dyscrasias.
Dental Drug Interactions: NSAIDs decrease hypotensive effect of this medication.
Action: Alpha-adrenergic antagonist, beta-adrenergic stimulators. Acts directly on vascular smooth muscle causes cardiac stimulation and uterine relaxation.
Use: Symptoms of cerebrovascular insufficiency, peripheral vascular disease such as arteriosclerosis obliterans, thromboangitis obliterans and Raynaud’s disease.
Dental Considerations: Local anesthesia with vasoconstrictor ok.
Dental Drug Interactions: Increases effects of alcohol.
Angiotensin Converting Enzyme (ACE) Inhibitors
Action: Inhibiting this enzyme prevents angiotensin I converting to angiotensin II. ANGIOTENSIN II is potent vasoconstrictor, results in increased renin release, reduction in aldosterone secretion and lower blood pressure.
Use: Treat hypertension and congestive heart failure.
Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, headache, orthostatic hypotension, angioedema, paresthesias and blood dyscrasias.