DENTAL DRUG INTERACTIONS WITH LOCAL ANESTHETIC AND VASOPRESSORS

DENTAL DRUG INTERACTING DRUG CONSIDERATION ACTION

Local Anesthetics (LAs) Cimetidine, B-adrenergic Hepatic metabolism of Use LAs cautiously,
blocker (propranolol) amide LA may be especially repeat dosages
depressed

Antidysrhythmics Additive CNS, CVS Use LAs cautiously – keep

(mexiletine, tocainide) depression dose as low as possible to
achieve anesthesia

CNS depressants: alcohol, Possible additive or supra- Consider limiting the

antidepressants, additive CNS, respiratory maximum dose of LAs,
antihistamines, depression especially with opioids
benzodiazepines,
antipsychotics, centrally
acting antihypertensive,
muscle relaxants, other
LAs, opioids
Cholinesterase inhibitors, Antimyasthenic drug Physician consultation
antimyasthenics, dosage may require
antiglaucoma drugs adjustment because LA
inhibits neuromuscular
transmission
Vasoconstrictors; a-Adrenergic blockers Possible hypotensive Use vasoconstrictor
epinephrine (phenoxybenzamine, response following large cautiously – as low a dose
prazosin); antipsychotics dose of epinephrine as possible
(haloperidol, entacapone)

Catecholamine-O- May enhace systemic Use vasoconstrictor

methyltransferase actions of cautiously – as low a dose
inhibitors (tolcapone, vasoconstrictors as possible
entacapone)

CNS stimulants Effects of stimulant or Use vasoconstrictor

(amphetamine, vasoconstrictor may occur cautiously – as low a dose
methylphenidate); ergot as possible
derivatives
(dihydroergotamine,
methysergide)
Cocaine Effects of stimulant or Avoid use of
vasoconstrictor; can result vasoconstrictor in patient
in cardiac arrest under influence of
cocaine

Digitalis glycosides Risk of cardiac Physician consultation

(digoxin, digitoxin) dysrhythmias

Levodopa, thyroid Large dose of either Use vasoconstrictor

hormones (levothyroxine, (beyond replacement cautiously – as low a dose
liothyronine) doses) may risk cardiac as possible
doses

Tricyclic antidepressants May enhance systemic Avoid use of

(amitriptyline, dosepin, effects of vasoconstrictors levonordefrin or
imipramine) norepinephrine; use
epinephrine cautiously –
as low dose as possible
Nonselective B-blockers May lead to hypertensive Monitor BP after initial LA
(propranolol, nadolol) responses, especially injection
epinephrine