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


Use: Candida species causing oral, vaginal and intestinal infections



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Use: Candida species causing oral, vaginal and intestinal infections.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Stevens-Johnson syndrome. Pregnancy risk factor B/C. Lactation ok.

Medical Considerations: 1-10%; nausea, vomiting, diarrhea and abdominal pain. Other adverse reactions; rash, anorexia, cramps and urticaria.

Drug Interactions: None

Antifungal Agent

Clotrimazole (Mycelex Troche)

Action and Use: Same as nystatin.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Pregnancy risk factor B, C for oral, lactation ok.

Medical Considerations: >10%; abnormal liver function tests. 1-10%; nausea, vomiting. Mild burning, irritation, stinging to skin or vaginal area.

Medical Drug Interactions: Increases activity of cyclosporines and sulfonylureas.

Antifungal Agent +

Betamethasone and Clotrimazole (Lotrisone)

Action: Anti-inflammatory plus antifungal.

Use: Topical treatment of various dermal fungal conditions.

Dental Considerations and Drug Interactions: Nothing major, same as individual components.

Antiviral Agent

Acyclovir (Zovirax)

Action: Inhibits DNA synthesis and viral replication.

Use: Treatment of initial and prophylaxis of recurrent oral mucosal and cutaneous herpes simplex (HSV-1 and HSV-2) infections.

Use: Treat herpes genitalis (HSV-1 and HSV-2), herpes zoster, varicella (chicken pox), herpes simplex encephalitis and herpes zoster ophthalmicus.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache, glossitis and blood dyscrasias. Don’t use if pregnant, lactation ok.

Medical Considerations: 1-10%; convulsions, tremors, dizziness, confusion, lethargy, agitation, coma, rash, nausea, vomiting and elevated creatinine.

Medical Considerations: Other adverse reactions; hallucinations, diarrhea, increased ALT/AST, abdominal pain, colitis, vaginitis, monoliasis, glomerulonephritis, acute renal failure, changes in menses, oliguria, proteinuria, hematuria, urticaria and pruritis.

Dental Drug Interactions: None

Medical Drug Interactions: Increased CNS side effects with zidovudine (AIDS drug) and probenecid.

Precautions: Hepatic and renal disease, electrolyte imbalance, dehydration.


  • Protease Inhibitor

Action: Prevents cleavage of protein precursors essential for HIV infection

of new cells and viral replication.



Use: Treatment of HIV, especially advanced cases, as part of triple or

double therapy with other nucleoside and protease inhibitors.



Dental Considerations: Local anesthesia with vasoconstriction ok.

Circumoral paresthesia and headache.



Dental Drug Interaction: Risk cardiac arrhythmias with some antihistamines. Increases concentration of benzodiazepines,

Antiviral Agent





  • Protease Inhibitor f(continued)

meperidine, piroxicam and propoxyphene. Dexamethasone decreases

effects. Azole antifungals, ketoconazole, increases effects, can also be



cardiotoxic.

Ritonavir (Norvir)

Indinavir (Crixivan)

Saquinavir (Invirase) Stevens-Johnson syndrome, blood dyscrasias.

Nelfinavir (Viracept)

Amprenavir (Agenerase)


  • Nucleoside Analog

Action: Inhibit HIV replication in both T cells and monocytes. Block viral

DNA synthesis.



Use: Treatment of advanced HIV infection.

Dental Considerations: Local anesthesia with vasoconstrictor ok.

Headache, blood dyscrasias.



Dental Drug Interactions: Decreases absorption of tetracyclines.

Decreases absorption of oral azole antifungals.



Didanosine (Videx)


Action: Interferes with HIV viral RNA dependent DNA polymerase resulting in inhibition of viral replication.

Use: Management of Aids patients.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Severe

Headache and blood dyscrasias.



Dental Drug Interactions: Inhibit excretion of acetaminophen,

indomethacin, lorazepam and aspirin.



Zidovudine (Retrovir, AZT)


Antiviral Agent





  • Lamivudine (Epivir, 3TC)

Action: Inhibits HIV reverse transcription via viral DNA chain termination and inhibits

RNA and DNA dependent DNA polymerase activities of reverse transcriptase.



Use: In combination with AZT and protease inhibitor for HIV where disease is

progressing, with AZT for HIV prophylaxis following needle sticks, treatment of

Hepatitis B.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache,

paresthesia, fever, chills, blood dyscrasias, myalgia and arthralgia.



Dental Drug Interactions: None.

Zidovudine and Lamivudine (Combivir, AZT + 3TC)

Stavudine (Zerit) Treat advanced HIV when problems with other agents


  • Ganciclovir (Cytovene, Vitrasert)

Action: Inhibits binding of deoxyguanosine triphosphate to DNA polymerase

resulting in inhibition of viral DNA synthesis.



Use: CMV retinitis, pneumonia, colitis, and mulitorgan involvement with

Aids patients, marrow transplant recipients.



Dental Considerations: Local anesthesia with vasoconstrictor ok.

Headache, blood dyscrasias, fever and paresthesias.



Dental Drug Interactions: None.


  • Etavirenz (Sustiva)

Action: A non-nucleoside reverse transcriptase inhibitor.

Use: Treat HIV-1 infections, hepatitis B and herpes viruses.

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

mouth, altered taste, TMJ-arthralgia, TMJ-myalgia, TMJ-tinnitus, blood dyscrasias,

paresthesia.

Dental Drug Interactions: Decreases clarithromycin and warfarin effects. Increases

effects of midazolam and triazolam effects.





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