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


Dental & Medical Considerations



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Dental & Medical Considerations: <1%; Stevens-Johnson syndrome, angioedema, hyperkalemia, hot flashes, polydipsia, cystitis, hepatitis, peripheral neuropathy,


Non-Narcotic Analgesic

  • Acetic Acid derivative NSAIDs (Continued)

depression, corneal opacities, visual disturbances dry eyes, polyuria, renal failure, dyspnea, allergic rhinitis, epistaxis and aseptic meningitis.

Dental & Medical Considerations: Not recommended pregnancy, lactation. Nabumetone & Etodolac (pregnancy C).

Drug Interactions: Same as other NSAIDs plus decreases antihypertensive effects beta-blockers, hydralazine and captopril. Increases serum potassium of potassium sparing diuretics. Nephrotoxic with cyclosporine. Increases toxicity of digoxin and aminoglycosides. Probenecid increases this medications serum concentration.

Indomethacin (Indocin)

Diclofenac (Cataflam, Voltaren)

Nabumetone (Relafen)

Etodolac (Lodine)

Sulindac (Clinoril) Tendinitis, bursitis and ankylosing spondylitis. White spots mouth or lips, aphthous stomatitis, glossitis.

  • Other NSAIDs

Diflunisal (Dolobid)

Use: Mild to moderate pain

Dental Considerations: Dry mouth, headache and blood dyscrasias. No pregnancy, lactation.

Medical Considerations: >10%; fluid retention. 1-10%; GI ulceration.

Medical Considerations: Other adverse reactions; convulsions, stimulation, drowsiness, dizziness, confusion, flushing, hallucinations, coma, pulmonary edema, rapid pulse, vomiting, diarrhea, heartburn, hepatitis, anorexia, wheezing, hyperpnea and blurred vision. Other adverse reactions; decreased acuity, corneal deposits, rash, urticaria, bruising, hypoglycemia, hyponatremia and hypokalemia.

Drug Interactions: Decreased effect with antacids. Increased toxicity with digoxin, methotrexate, anticoagulants, phenytoin and sulfonylureas. Increased toxicity with sulfonamides, indomethacin, hydrochlorothiazide, lithium and acetaminophen.

Precautions: Don’t use if GI bleeding, PUD, possibility of Reyes syndrome. Minimal effect on platelets, greater uricosuric effect.

Piroxicam (Feldene)

Use: Arthritis, including gouty arthritis.

Dental Considerations: Stomatitis, bleeding, dry mouth, blood dyscrasias, headache and tinnitus. Local anesthesia with vasoconstrictor ok. Don’t use if pregnant or breast-feeding.

Medical Considerations: >10%; dizziness, skin rash, abdominal cramps, heartburn, indigestion, and nausea.

Medical Considerations: 1-10%; nervousness, itching, fluid retention, vomiting.


Non-Narcotic Analgesic
  • Other NSAIDs

Piroxicam (Feldene) continued

Medical Considerations: Other adverse reactions; drowsiness, insomnia, depression, malaise, somnolence, nervousness, vertigo, peripheral edema, nausea, anorexia, vomiting, diarrhea, cholestatic hepatitis, jaundice, constipation, flatulence, peptic ulcer, epigastric distress, GI bleeding, nephrotoxicity, hematuria, oliguria, azotemia, hearing

loss, blurred vision, purpura, rash, pruritis, sweating, photosensitivity, elevated ALT/AST and hypoglycemia.

Drug Interactions: GI ulcer, bleeding with aspirin, alcohol and corticosteroids. Nephrotoxicity with acetaminophen (prolonged use, high dose). Decreased action salicylates. Risk of increased effects oral anticoagulants, oral antidiabetics, lithium and methotrexate. Decreased antihypertensive effects of diuretics, B-adrenergic blockers and ACE inhibitors. Decreased effect with aspirin, antacids and cholestyramine

Precautions: Asthma, renal and hepatic disease, children, bleeding disorders, GI disorders, cardiac disorders, hypertension.



Mefenamic Acid (Ponstel)

Use: Short term relief of mild to moderate pain including dysmenorrhea.

Dental Considerations: Local anesthesia with vasoconstrictor ok..

Headache, tinnitus, erythema multiforme, Stevens-Johnson syndrome, blood dyscrasias.



Dental Drug Interactions: Increases effects of oral anticoagulants.

Decreased effect with aspirin.




  • COX-2 Inhibitor NSAIDs


Action: NSAIDs inhibit isoenzymes cyclooxygenase-1, COX-1, and

cyclooxygenase-2, COX-2. This inhibits prostaglandin synthesis. These

drugs have no effect on COX-1, which causes most of GI side effects of

NSAIDs.


Use: Signs and symptoms of osteoarthritis, mild acute pain and primary

dysmenorrhea.



Dental Considerations: Local anesthesia with vasoconstrictor ok.

Sinusitis, headache, aphthous stomatitis, dry mouth, oral ulcer, blood

dyscrasisas, chills, tinnitus, arthralgia, myalgia, hypesthesia, paresthesia,

post extraction alveolitis.



Dental Drug Interactions: Don’t use with aspirin, increased activity of

oral anticoagulants.



Medical Considerations and Drug Interactions: Same as other NSAIDs.

Celecoxib (Celebrex) only can use for arthritis.

Rofecoxib (Vioxx) Introduced May 21, 1999.

Non-Narcotic Analgesic
  • Other NSAIDs




  • Para-aminophenol derivatives

Action: Inhibits prostaglandin synthesis, more effectively in CNS than peripherally. Thus is analgesic and antipyretic, but not anti-inflammatory. Also no gastric bleeding, no effect on platelet adhesion or uric acid excretion.

Use: Treat mild pain and fever.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Blood dyscrasias. Pregnancy and lactation ok.




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