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


Increased risk respiratory depression with anesthetics and alcohol. Increased risk



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Increased risk respiratory depression with anesthetics and alcohol. Increased risk

sedation with other CNS depressants and alcohol. Decreased activity with

carbamazepine. Increased activity with cimetidine and quinidine. Increased risk of

seizures MAO inhibitors, TCAs and serotonin reuptake inhibitors.




Opium Alkaloid +

Hydrocodone and Acetaminophen (Anexia, Bancap, Co-Gesic, Lorcet, Lortab and Vicodin)

*Hydrocodone and Acetaminophen

*Allergic cross reactions with other phenanthrene derivatives (morphine, codeine,

levorphanol, oxycodone and oxymorphone). Increased CNS depression with alcohol,

phenothiazines, sedative/hypnotics, skeletal muscle relaxants, general anesthetics and

other opiods. Increased effects of anticholinergics, may cause paralytic ileus.

Use of antidepressants (MAO inhibitors or TCAs) and hydrocodone can increase

effects of both antidepressant and hydrocodone.

Hydrocodone and Aspirin (Lortab ASA)

Same drug interactions as individual components.

Acetaminophen and *Codeine (Capital and Codeine, Phenaphen with Codeine, Tylenol with Codeine)

*Similar drug interactions as individual components. Codeine acts as hydrocodone.

Acetaminophen and *Oxycodone (Percocet, Tylox)

*Class II narcotic. Same drug interactions as individual components with Oxycodone acting as Hydrocodone

Aspirin and Oxycodone (Percodan)

Same drug interactions as individual components, with Oxycodone acting as codeine.

Synthetic, Meperidine Group

Meperidine (Demerol)

Increased effects with all CNS depressants, anticholinergics. Effect increased by

MAO inhibitors, TCAs, phenothiazine, fluoxetine, cimetidine and other serotonin

Uptake inhibitors. Dilantin decreases effect. Aggravates adverse effects of isoniazid.

Don’t use if MAO inhibitor given in previous 14 days.

Don’t use with Selegiline (Eldepryl), serotonin syndrome.


  • Narcotic Analgesic

Synthetic, Meperidine Group

Fentanyl Transdermal System (Duragesic Patches)

Effects increased with other CNS depressants and skeletal muscle depressants.

Increased anticholinergic effect with anticholinergics. Additive hypotension with

nitrous oxide and benzodiazepines. Effects increased by chlorpromazine and

cimetidine. Additive hypotension with phenothiazines.

Synthetic, Methadone Group

Propoxyphene (Darvon, Darvon-N)

Decreased effect with charcoal (cigarettes). Increased toxicity with other CNS

depressants and skeletal muscle relaxants. Increases effects of warfarin and

anticholinergics.

Increases effects of carbamazepine, barbiturates, MAO inhibitors and TCAs.

Synthetic, Methadone Group+

Propoxyphene and Acetaminophen (Darvocet-N, Darvocet-N 100, Propacet, Wygesic) Same drug interactions as individual components.

Propoxyphene and Aspirin (Darvon Compound-65 Puvules)

Same drug interactions as individual components.

Synthetic, Benzomorphan Group

Pentazocine (Talwin, Talwin NX)

Increased effect of CNS depressants. May potentiate or reduce analgesic effect of opiate. Can cause withdrawal in narcotic addicts. Increased effects of anticholinergics. Don’t give with MAO inhibitors. Can be lethal with antihistamine tripelennamine (PBZ, PBZ-SR). Increased effect with phenothiazines.




  • Anti-Anxiety Agents

Benzodiazepines

CNS depressants (alcohol, barbiturates, opiods) enhance sedative and respiratory

depressant effects of this medication. Increased effect of medication by erythromycin

and antifungals. Increased medication effect with cimetidine, cisapride, valproic acid,

antihistamines and selective serotonin reuptake inhibitors, oral contraceptives.

Alprazolam (Xanax)

Diazepam (Valium)

Temazepam (Restoril)

Lorazepam (Ativan) Increased toxicity with MAO inhibitors, tricyclic antidepressants, phenothiazines.

Clorazepate (Tranxene)




  • Anti-Anxiety Agents

Benzodiazepines (continued)

Flurazepam (Dalmane)

Triazolam (Halcion)

  • Skeletal Muscle Relaxant

Carisoprodol (Soma)

Increased CNS depression all CNS depressants. Increased CNS depression with phenothiazines and MAO inhibitors.

Chlorzoxazone (Parafon Forte)

Increased CNS depression with alcohol, narcotics, barbiturates, sedatives, hypnotics.

Cyclobenzaprine (Flexeril)

Increased CNS depression with alcohol, narcotics, barbiturates, sedatives, hypnotics. Increased effects of anticholinergics. Increased toxicity with TCAs. Increased effect of direct acting sympathomimetics (epinephrine and levonordefrin).

Orphenadrine (Norflex)

Increased CNS depression with CNS depressants. Increased anticholinergic effect

with anticholinergics.







Question #1
How does Aldosterone work? Specifically can you explain the relationship of Aldosterone to angiotensin, renin and antidiuretic hormone, vasopressin?

Question #2


What is Rhabdomyolysis?

Question #3


What’s with all these different neurotransmitters and how exactly do they work?

Question #4


How much do you know about pigs?

Question #5


Stop! (Pause)
I feel overloaded with information! (Pause)
Before we start clinical cases, can’t you logically explain the patterns of drug interactions?

It is my pleasure to welcome Michael L. Iczkovitz, D.D.S. to The Northern Nevada Dental Society. Dr. Iczkovitz is a Diplomate of the American Board of Oral and Maxillofacial Surgery and is in the clinical practice of oral and maxillofacial surgery in Ft. Wayne, IN. He obtained his undergraduate and dental school education at the University of Michigan. He did a general practice residency at the Michael Reese Medical Center in Chicago. His oral and maxillofacial surgery residency was at the University of Pennsylvania in Philadelphia. Dr. Iczkovitz has presented this lecture to numerous dental societies throughout the United States to enhance the expertise and enjoyment of the entire dental profession.









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