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



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Use: Short term treatment of insomnia.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, taste alterations, tinnitus, headache and myalgia.

Dental Drug Interactions: Additive effect with other CNS depressants.

Zolpidem (Ambien)



Zalepion (Sonata)

Action: Binds with benzodiazepine GABA receptor complex.

Use: Short term treatment of insomnia.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache,

Hypesthesia, paresthesia, and myalgia.



Dental Drug Interactions: Additive effect with other CNS depressants.

Anti-Anxiety Agent

Buspirone (BuSpar)

Action: Selectively antagonizes CNS serotonin receptors, little potential for abuse.

Use: Treat anxiety and panic attacks.

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

Dental Drug Interactions: Increased sedation alcohol, all CNS depressants.

Hydroxyzine (Vistaril, Atarax)

Action: Depresses subcortical levels of CNS. Antagonist for histamine H-1 receptors in GI and respiratory tracts and blood vessels.

Use: Treat anxiety, as a preoperative sedative. Also used as antipruritic, antiemetic and in alcohol withdrawal.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, headache, arthralgia and pharyngitis. Avoid in pregnancy, no data on lactation.

Medical Considerations: >10%; drowsiness, thickening of bronchial secretions. 1-10%; fatigue, nervousness, dizziness, appetite increase, weight gain, nausea, abdominal pain and diarrhea.

Anti-Anxiety Agent

Hydroxyzine (Vistaril, Atarax)

Medical Considerations: Other adverse reactions; confusion, tremors, fatigue, depression and convulsions.

Medical Considerations: Use with caution if narrow-angle glaucoma, prostatic hypertrophy and bladder neck obstruction.

Dental Drug Interactions: Increased CNS depressant effects of alcohol, all CNS depressants. Increased anticholinergic effects other antihistamines, opiod analgesics and anticholinergics.




  • Phenothiazine

Action: Causes dopaminergic neurotransmitter blockade in the cerebral cortex, hypothalamus and limbic system and depresses hormone release. Also strong peripheral Alpha-adrenergic blockade, anticholinergic.

Use: Psychotic disorders, mania, schizophrenia, anxiety, intractable hiccups, nausea, vomiting, preoperative relaxation, acute intermittent porphyria, Tourette’s Syndrome and behavior problems in children.

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

Dental Drug Interactions: Increased sedation other CNS depressants, alcohol, barbiturates, opiod analgesics. Increased photosensitivity tetracyclines.

Chlorpromazine (Thorazine)

Fluphenazine (Prolixin) Adjunct to TCAs in neurogenic pain.

Thioridazine (Mellaril) Dementia in elderly.

Perphenazine (Trilafon) Dementia symptoms, Huntingtons chorea, spasmotic torticollis and Reye’s syndrome.


Trifluoperazine (Stelazine)

Anti-Psychotic Agent

Risperidone (Risperdal)

Action: In CNS blocks serotonin and dopamine receptors. Peripherally blocks alpha and histamine receptors.

Use: Manage psychotic disorders, nonpsychotic symptoms associated with dementia in elderly.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Significant dry mouth, stomatitis, taste alteration, orthostatic hypotension, headache, blood dyscrasias, sinusitis and arthralgia.

Dental Drug Interactions: Increased sedation CNS depressants, additive photosensitivity tetracyclines.



Anti-Psychotic Agent

Haloperidol (Haldol)

Action: Blocks neurotransmission of dopamine in cerebral cortex, hypothalamus and limbic system. Exhibits strong peripheral alpha adrenergic and anticholinergic blocking.

Use: Treat psychosis, Tourette’s syndrome, autism and severe behavior problems in children. Used for emergency sedation in severely agitated or delirious patients. Treat chemotherapy induced nausea and vomiting.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, sore throat and mouth, tardive dyskinesia tongue and lip movements, headache. Orthostatic hypotension, extrapyramidal symptoms of TMJ and laryngospasm.

Dental Drug Interactions: Barbiturates decrease effect of medication, increased sedation with CNS depressants and increased photosensitivity with tetracyclines.

Quetiapine (Seroquel)


Action: Agonist for serotonin receptors and to lesser extent dopamine receptors.

Use: Schizophrenia

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, taste perversion, headache, orthostatic hypotension, blood dyscrasias, ear pain, pharyngitis.

Dental Drug Interactions: Increased CNS depression with CNS depressants.

Olanzapine (Zyprexa)


Action: Antagonizing dopamine and serotonin activities.

Use: Psychotic disorders

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

xerostomia, arthralgia.



Dental Drug Interactions: Increased sedation with CNS depressants.
Clozapine (Clozaril, Leponex)

Action: Blocks serotonin, alpha-adrenergic, histamine H-1 central nervous system

receptors, weak dopamine blocker.



Use: Schizophrenia

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache, dry mouth,

blood dyscrasias, fever, increased salivation, glossitis.



Dental Drug Interactions: Increases CNS depression all CNS depressants. Increased

anticholinergic effects anticholinergics. Erythromycin and clarithromycin may

increase clozapine concentration.
Ziprasidone (Geodon)

Action: Mixed reuptake inhibitor of serotonin and norepinephrine.

Use: Treatment of schizophrenia

Dental Considerations: Local anesthesia with vasoconstrictor ok.

Dental Drug Interactions: Additive CNS depression with other CNS depressants.

Ketoconazole increases concentration of Ziprasidone.


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