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



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Dental Drug Interactions: Barbiturates and oral antibiotics (effects on GI bacteria producing Vitamin K), alcohol decreases anticoagulant effects of this medication.




Antiplatelet Agent

  • Dipyridamole (Persantine)


  • Cilostazol (Pletal)

Action: Inhibits ability of platelets to aggregate through effects on adenosine, cAMP and thromoxane A2. May also cause peripheral and coronary vasodilatation.

Use: Prevention of transient ischemic attacks (TIAs), MI, thromboembolism, with warfarin for prosthetic heart valves, with aspirin to prevent occlusion of coronary artery bypass grafts (CABGs).

Dental Considerations: Local anesthesia with vasoconstrictor ok. Gingival bleeding, headache, migraine, postural hypotension.

Dental Drug Interactions: Additive antiplatelet effects with aspirin and other NSAIDs.





  • Ticlopidine (Ticlid)

Action: Inhibits first and second phases of ADP induced effects of platelet

aggregation.



Use: Reduce risk of stroke in high-risk patients. Prophylaxis for CABG,

diabetic microangiopathy, ischemic heart disease, deep vein thrombosis,

post renal transplant.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Blood

dyscrasias and tinnitus.



Dental Drug Interactions: Increased bleeding with anticoagulants, aspirin

and NSAIDs.



Antiplatelet Agent

  • Clopidogrel (Plavix)

Action: Indirectly blocks binding of fibrinogen to the ADP receptor

Use: Reduction of atherosclerotic events (myocardial infarction, stroke, vascular deaths)

in patients with atherosclerosis documented by recent MI, stroke or established

peripheral arterial disease.

Dental Considerations: Local anesthesia with vasoconstrictor ok.


Dental Drug Interactions: None
Blood Viscosity Reducing Agent

  • Pentoxifylline (Trental)

Action: Decreases blood viscosity.

Use: Intermittent claudication due to chronic occlusive arterial disease of limbs.

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

Dental Drug Interactions: May increase coumadin activity.

Cholesterol Lowering Agents

  • HMG-CoA Reductase Inhibitors:

Action: Inhibits enzyme involved in cholesterol biosynthesis, thus lowers cholesterol production.

Use: Treat primary hypercholesterolemia.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache, arthralgia, facial paresis, dryness of mucous membrane and myalgia.

Dental Drug Interactions: Increased effect of Erythromycin and Warfarin. Don’t use with Erythromycin and azole antifungals, can result in rhabdomyolysis.

Simvastatin (Zocor)

Pravastatin (Pravachol)

Lovastatin (Mevacor)

Fluvastatin (Lescol)

Atorvastatin (Lipitor)


Cerivastatin (Baycol) removed from market August 2001, fatal rhabdomyolysis at high doses and when mixed with Lopid.

Cholesterol Lowering Agents

  • Miscellaneous

Gemfibrozil (Lopid)

Action: Mechanism of action unknown.

Use: Treat hypertriglyceridemia, coronary heart disease with increased LDL cholesterol, triglycerides and low HDL cholesterol.

Dental Considerations: Local anesthesia with vasoconstrictor ok, paresthesia, hypesthesia, headache and blood dyscrasias.

Dental Drug Interactions: May potentiate effects of warfarin.




  • Miscellaneous

Niacin (Slo-Niacin, Nicobid)

Action: Vitamin B 3 inhibits synthesis of low-density lipids (LDL). Needed for conversion of fats, proteins and carbohydrates. Acts directly on vascular smooth muscle to cause vasodilatation.

Use: Treat hypercholesterolemia, niacin deficiency = pellagra (may arise from chronic alcoholism, GI disturbances, pregnancy, hyperthyroidism, and infections).

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

Dental Drug Interactions: Drug effect decreased by Aspirin.

  • Miscellaneous

Cholestyramine Resin (Questran)

Action: Absorbs, combines with bile acids to form insoluble complex that is excreted through feces. Loss of bile acids lowers cholesterol.

Use: Treat hypercholesterolemia, pruritis with elevated bile acids, diarrhea secondary to excess fecal bile acids, binding toxicological agents, pseudomembraneous colitis.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Tongue irritation, headache, tinnitus, muscle and joint pain.

Dental Drug Interactions: Decreased absorption of tetracyclines, cephalexin, barbiturates, corticosteroids, clindamycin, penicillins, warfarin and NSAIDs.




  • Miscellaneous


Coesevelam (WelChol)

Action: Binds with bile acids in the intestine, increases fecal loss and lowers LDL.

Use: Treat elevated levels of LDL.

Dental Considerations: Local anesthesia with vasoconstrictor ok. TMJ-myalgia,

pharyngitis.



Dental Drug Interactions: None

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