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



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Fluoxetine (Prozac)


Anti-Depressants
  • Selective Serotonin Reuptake Inhibitors (continued)

Sertraline (Zoloft) Panic disorders, myalgia

Paroxetine (Paxil) Anxiety, glossitis, salivary gland enlargement.

Fluvoxamine (Luvox) Panic disorders, increased salivation (more often dry mouth), postural hypotension


Citalopram (Celexa)
  • Antimanic Agent

Action: Blocks CNS reuptake of serotonin and norepinephrine. Also alters sodium and potassium ion transport across nerve and muscle cells.

Use: Treat acute manic episodes, bipolar manic depressive psychosis, depression and vascular headaches.

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

Dental Drug Interactions: Do not use Aspirin, Indomethacin or other NASIDs with, causes lithium toxicity. Xanthines (caffeine) with decrease effect of lithium.

Lithium (Eskalith)




Trazodone (Desyrel)

Action: Inhibits CNS reuptake of serotonin and norepinephrine.

Use: Depression, chronic pain, painful diabetic neuropathy and burning mouth syndrome.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, bad taste, stomatitis, headache and orthostatic hypotension.

Dental Drug Interactions: Decreases effect of anticoagulants. Increases effect of CNS depressants.




Nefazodone (Serzone)

Action: Inhibits CNS reuptake of serotonin and norepinephrine.

Use: Major depressive orders.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, taste alteration, candidiasis, stomatitis, headache, orthostatic hypotension, pharyngitis.

Dental Drug Interactions: Significant adverse reaction with alcohol.




Bupropion (Wellbutrin, Zyban)

Action: Weak CNS reuptake inhibitor of serotonin, norepinephrine and dopamine.

Use: Treat depression and tobacco addiction.

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

Dental Drug Interactions: Increased seizure activity with benzodiazepines and alcohol.


Anti-Depressants
  • Miscellaneous Antidepressants

Venlafaxine (Effexor)

Action: Inhibits both norepinephrine and serotonin CNS reuptake. Weak inhibitor of dopamine reuptake.

Use: Depression.

Dental Considerations: Local anesthesia with vasoconstrictor ok.

Dental Considerations: Significant dry mouth, glossitis, cheilitis, gingivitis, candidiasis, postural hypotension, blood dyscrasisas and headache.




Anti-Anxiety Agent

  • Benzodiazepines

Action: Decreases all levels of the CNS, including the limbic and reticular formation. Does this by facilitating the action of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter.

Use: Treat anxiety, panic and seizure disorders. Treat skeletal muscle spasm, acute alcohol withdrawal and used in conscious sedation.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Significant dry mouth or sometimes increases in salivation. Orthostatic hypotension, tinnitus. Not compatible with pregnancy or breast-feeding.

Medical Considerations: >10%; drowsiness, ataxia, amnesia, slurred speech, light-headedness, phlebitis, pain with injection. 1-10%; confusion, dizziness.

Other adverse reactions; insomnia, hallucinations, EKG changes, tachycardia, hypotension, constipation, nausea, vomiting, anorexia, diarrhea, blurred vision, mydriasis, rash, dermatitis, itching. Don’t use with narrow-angle glaucoma, pre-existing CNS and respiratory depression, psychosis and severe uncontrolled pain. Use with caution in elderly, debilitated, hepatic and renal disease.

Dental Drug Interactions: CNS depressants (alcohol, barbiturates, opiods) enhance sedative and respiratory depressant effects of this medication. Increased effect of medication by erythromycin and antifungals.

Medical Drug Interactions: Increased medication effect with cimetidine, cisapride, valproic acid, antihistamines and selective serotonin reuptake inhibitors, oral contraceptives.

Alprazolam (Xanax) Headache, taste alteration.

Diazepam (Valium)

Temazepam (Restoril)

Lorazepam (Ativan) Antiemetic, insomnia, psychogenic catatonia. Increased toxicity with MAO inhibitors, tricyclic antidepressants, phenothiazines.

Clorazepate (Tranxene)

Flurazepam (Dalmane) Short-term treatment of insomnia.

Triazolam (Halcion) Short-term treatment of insomnia, preoperative sedative.

Anti-Convulsant

  • Benzodiazepines

Clonazepam (Klonopin)

Use: Treat petit mal and variant (Lennox-Gastaut), akinetic and myoclonic seizures, restless legs syndrome, neuralgia. Multifocal tic disorder, parkinsonian dysarthria, acute manic episodes, panic disorder and adjunct for schizophrenia.

Clonazepam Headache, blood dyscrasias.




Sedative-Hypnotic

Action: Interacts with a subunit of the GABA-benzodiazepine receptor. Same hypnotic and anxiolytic effects as benzodiazepines, but reduced effects on skeletal muscle relaxation and seizure activity.

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