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Drug Interactions Important in Clinical Dentistry
2006 K. Baker
Static agent may impair action of penicillins. (clindamycin, erythromycin, tetracyclines) Consult with other prescriber for modification. Rare decrease in estrogen effect. Use barrier contraception for duration of pill cycle. additional barrier contraception for the remainder of the Pill pak. Tubular secretion of penicillins may be decreased. Usually not problematic. Doubling in rate of ampicillin rash with concurrent administration (14-22%) Atenolol bioavailability may be reduced. Risk of bleeding disorders might be increased in anticoagulated patients. Use cautiously. (clindamycin, erythromycin, tetracyclines) cephalosporins. Consult with other practitioner for modification. Tubular secretion of penicillins may be decreased. Usually not problematic. Reduced absorption of the cephalosporins. (Antacids, Axid, Pepcid, Prilosec, Tagamet, Possibility of antagonism. AVOID CONCURRENT USE. Delay in clindamycin absorption with concurrent use. Possibility of prolonged respiratory depression. Monitor patient. Alfentanil actions increased. Use caution. Risk of bleeding disorders is increased in anticoagulated patients. Monitor pt. clarithromycin (Biaxin, Biaxin XL, g) erythromycin (base, EC, EES, PCE) Increased benzodiazepine levels resulting in CNS depression. Avoid combination in elderly. CCBs (diltiazem (Cardizem,g) and verapamil Increased carbamazepine levels. Avoid concurrent use. Azithromycin is okay. Increased cyclosporine renal toxicity. Consult MD. Increased digoxin levels in 10% of patients. May use cautiously. Increased disopyramide levels may cause arrhythmias. Use cautiously. Acute ergotamine toxicity. Use cautiously Steroid clearance may be decreased. Caution. possible antagonism. Avoid static with cidal Avoid all macrolides-risk of sudden death Terfenadine (not available in the U.S. but still Increased terfenadine levels resulting in Increased statin levels with possible muscle Increased theophylline levels (20-25%). Decreased erythromycin levels may also occur. AVOID CONCURRENT USE if possible. SBE prophylaxis should not cause problems. Increased Detrol effects causing arrhythmias Metronidazole (Flagyl, Flagyl ER, Prostat, g) Risk of bleeding disorders is increased in anticoagulated patients. Consult MD. Cimetidine (Tagamet, g) Metronidazole levels may increase. Not sig. Risk of disulfuram-type reaction. AVOID CONCURRENT USE. Increased lithium levels with possible toxicity. Consult MD. Eff. of phenytoin may be incr. Monitor closely. Increased Quinidine levels. Monitor closely. Tetracyclines
All Agents
(doxycycline, minocycline, tetracycline) Doxycycline (Vibramycin, Periostat??)
Tetracycline (Sumycin, Panmycin)
All Agents:
Increased risk of bleeding disorders. Monitor Quinolone serum levels may be decreased. Quinolone serum levels may be increased. Cyclosporine renal toxicity may be enhanced. Quinolone serum level may be increased50%. Increased theophylline toxicity possible with Increased caffeine effects are possible. Kbaker,Drug Interactions Important in Clinical Dentistry.rtf12/5/2006 ANTIFUNGALS
Systemic Azole Agents (fluconazole, itraconazole, Increased cyclosporine levels. Can be used to the patients advantage. Rifampin Decreased levels of the antifungal. AVOID . "Statins" (Crestor,Lipitor, Mevacor,Zocor, etc.) Terfenadine (not available in the U.S.) Increased terfenadine levels resulting in serious cardiac arrhythmias. AVOID CONCURRENT USE. Increased Detrol-causing arrhythmias.AVOID Reduced fluconazole levels. AVOID CONCURRENT USE. Decreased estrogen levels. AVOID CONCURRENT USE. Increased phenytoin levels. Monitor carefully. Increased digoxin levels. AVOID COMBINATION. Increased hypoglycemic effects. Monitor blood glucose. Decreased ketoconazole levels. AVOID CONCURRENT USE. Decreased theophylline levels. Consult with MD. NON-NARCOTIC ANALGESICS
(including aspirin and COX-2s) Anticoagulants Increase risk of bleeding disorders in anticoagulated patient. Consult MD. Decreased antihypertensive effect. Monitor Nephrotoxicity of both agents may be increased. Avoid if possible. Toxicity of methotrexate may be increased. Monitor. Decreased NSAID levels with increased GI effects. AVOID CONCURRENT USE. Kbaker,Drug Interactions Important in Clinical Dentistry.rtf12/5/2006 Decreased sulindac effectiveness and severe peripheral neuropathy. Avoid concurrent use. Lithium levels remain constant or decrease. The hepatotoxicity of APAP may be increased by high dose or long term administration of these drugs. Decreased APAP absorption. Do not administer within 2 hours of each other. Increased hepatotoxicity of APAP with chronic Any drug that enhances serotonin activity(SSRI antidepressants,”triptans” for acute migraine NARCOTIC ANALGESICS
Alcohol, CNS depressants, local anesthetics, Increased CNS and respiratory depression antidepressants, antipsychotics, antihistamines, Antimuscarinics and antidiarrheals (e.g. atropine), Opioids increase the effects of these drugs. These drugs block the analgesic effects of opioids. Substitute with NSAIDs. Codeine 2D6 Inhibitors, Amiodarone, Cimetidine, Inhibition of biotransformation of Codeine to active analgesic form. Use different narcotic MAOIs (Marplan, Nardil, Parnate, Furoxone) hypotension.Avoid concurrent use if MAOI taken within 14 days. Large increase in meperidine. AVOID COMBO. LOCAL ANESTHETICS Alcohol,CNS
pressants,antipsychotics, antihistamines Metabolism of lidocaine is reduced. Use caution Anticholinesterases (Neostigmine) Sulfonamides Metabolism of esters reduced. Inhibit sulfonamide action. VASOCONSTRICTORS (epinephrine,levo-
Tricyclic antidepressants-high dose (amitriptyline, Increased sympathomimetic effects possible. desipramine, imipramine, nortriptyline, etc) Limit epi to 0.04mg with high dose TCA's. Hypertensive and/or cardiac rx possible. Vasoconstrictor action inhibited,leading to possible hypotensive responses. Use cautiously. Kbaker,Drug Interactions Important in Clinical Dentistry.rtf12/5/2006 AGENTS FOR PARENTERAL ANESTHESIA
Increased dry mouth, tachycardia, urinary Enhanced duration and intensity of sedation. Reduce dosages. Sulfa competes with barb. for binding sites. Smaller and more frequent barb. doses may have to be given. CNS depressants (anticonvulsants, alcohol) Oversedation so may use slower titration. Decreased clearance of diazepam. Can avoid Increased risk of underventilation or apnea. May Increased hypnotic effect of midazolam. More After premed with Versed, decrease dose of thiopental for induction by 15% CNS toxicity case reports only. (confusion, apnea, seizures) With high dose fentanyl gives CV depression. With high dose fentanyl may cause CV depress. Meperidine has predictable and sometimes fatal reactions with use within 14 days. TypeI :coma,resp dep,cyanosis,low BP Type2:seizures,hyperpyrexia,hypertension,tachy-cardia. AVOID CONCURRENT USE!!!!! Decrease meperidine effects by increased hepatic metabolism Halothane blocks the CV stimulate effect of ketamine.Closely monitor cardiac function. Ketamine may increase neuromuscular effects and result in prolonged resp. depression. CNS depressants (sedative/hypnotic, inhalation Increase CNS depression of propofol. Premed with narcotics may lead to more pronounced decrease in systolic, diastolic, and mean arterial pressures and cardiac output. Kbaker,Drug Interactions Important in Clinical Dentistry.rtf12/5/2006


Vol. 59, no 1, 2010, 55-60

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