INTERACTION BETWEEN
SPECIFIC DISEASES AND
DENTAL
PHARMACOLOGY
 Ischemic Heart Disease
Angina pectoris: Don’t give anticholinergics (Probanthine), increases cardiac rate
and oxygen demand, arrhythmias possible.
Previous myocardial infarction (MI): Don’t give aspirin or other NSAIDs for post
-op pain. If surgery and MD oks may want to be off aspirin 7-10
days pre-op.
 Asthma
Attacks stimulated by aspirin, NSAIDs, barbiturates,
Narcotics and cold air.
If taking theophylline no macrolide antibiotics (Erythromycin, Azithromycin or
Clarithromycin) or Ciprofloxacin, may cause theophylline toxicity.
Antihistamines should be used with caution due to drying effects.
Local anesthetics with epinephrine or levonordefrin contain sulfite preservatives,
may cause asthma attack.
Oral candidiasis possible with steroid inhalers.
If taking oral corticosteroids for one week in last six months may be adrenal
suppressed. If stressful procedure Adrenal Supplementation Regimen is to double
normal steroid dose day of procedure and first postoperative day.
Stress may cause asthma attack. Premedication with oral diazepam ok. Nitrous
Oxide during procedure is excellent, not a respiratory depressant and doesn’t
irritate tracheobronchial tree.
Have patient bring asthma medications to appointment. Ask if any asthma
symptoms prior to dental treatment.
 COPD
Avoid nitrous oxide, high oxygen flow may depress respiratory drive. Also nitrous
oxide accumulates in enlarged air spaces in lung with emphysema. If must use
oxygen use at low 2-4 liter flow rate.
Anticholinergics and antihistamines cause drying which increases mucous tenacity,
so don’t use. Narcotics and barbiturates can cause respiratory depression.
Watch for concomitant CAD and hypertension. If taking oral steroids may need to
follow Adrenal Supplementation Regimen. No office GA or IV sedation.
 COPD (continued)
If taking theophylline no macrolide antibiotics (Erythromycin, Azithromycin or
Clarithromycin) or Ciprofloxacin, may cause theophylline toxicity.
 Diabetes Mellitus
NPO rules for general anesthesia. Stop medications evening before surgery. Longer
acting oral agents must be stopped sooner. Glyburide (Diabeta, Micronase) stop 24
hours pre-op, Chlorpropamide (Diabinese) 36 hours and Metformin (Glucophage)
48 hours.
 Bleeding Disorders, GI Disease
Avoid aspirin, aspirin compounds and NSAIDs. Use acetaminophen and codeine.
 Kidney Failure
Heparin given during dialysis can cause bleeding problems. Perform dental surgical
procedures 4-30 hours after dialysis and 24-48 hours prior to next dialysis.
Avoid nephrotoxic drugs: NSAIDs, aminoglycosides, acyclovir, radiographic
contrast media. Meperidine and propoxyphene converted to renal toxic metabolites,
don’t use. Penicillin G and magnesium citrate have excessive electrolytes, don’t use.
Reduce dose of ketoconazole. Increase interval between doses with aspirin,
Acetaminophen, penicillin V, cephalexin and tetracycline.
No problems using the following drugs: Codeine, erythromycin, valium,
clindamycin and metronidazole (Flagyl).
 Liver Failure
Dental drugs metabolized primarily by the liver: Local anesthetics; Lidocaine
(Xylocaine), Mepivacine (Carbocaine), Prilocaine (Citanest) and Bupivacaine
(Marcaine). Analgesics; Aspirin, Acetaminophen, Codeine, Meperidine (Demerol)
Ibuprofen (Motrin) and Propoxyphene (Darvon). Sedatives; Diazepam (Valium)
and Barbiturates. Antifungals; Ketoconazole. Antibiotics: Ampicillin, Penicillin,
Erythromycin, Clindamycin, Metronidazole and Tetracycline.
Most drugs used in dentistry metabolized by liver. Unless severe hepatic
Dysfunction can use drugs in limited quantity (Three cartridges 2% lidocaine is
108 mg, ok).
 Immunocompromised
HIV+: No antibiotic prophylaxis necessary.
AIDS: Antibiotic prophylaxis.
 Immunocompromised (continued)
HIV Drugs:
Protease inhibitors ritonavir (Norvir), indinavir (Crixivan), Saquinavir (Invirase)
and benzodiazepines increase benzodiazepine levels. Adjust benzodiazepine dose
or don’t use. Azole antifungals, ketoconazole, clarithromycin mixed with protease
inhibitors can be cardiotoxic with fatal arrhythmias. Produces large increases in
concentrations of meperidine and propoxyphene, don’t use with protease inhibitors.
Metronidazole and liquid ritonavir (contains alcohol) get disulfarim (Antabuse)
like reaction.
Some antihistamines) mixed with protease inhibitors can be cardiotoxic with fatal
arrhythmias.
Organ Transplant Drugs:
Follow Adrenal Supplementation Regimen if on steroids and procedure is
stressful.
Cyclosporin is hepatotoxic, neurotoxic and causes hypertension and gingival
hyperplasia.
Azathioprine (Imuran) causes hepatotoxicity, thrombocytopenia and leukopenia.
Mycophenolate (CellCept) causes leukopenia. Don’t use NSAIDs,
aminoglycosides and acyclovir with mycophenolate as causes nephrotoxicity.
Tarcolimus, a potent macrolide immunosuppressant, is nephrotoxic, neurotoxic
and diabetogenic. Macrolide antibiotics, azole antifungals and corticosteroids
Increase tarcolimus concentration.
Antihistamines terfenadine (Seldane) and astemizole (Hismanal) cause cardiac
arrhythmias when used with tacrolimus and cyclosporine.
If WBC < 2,000 need antibiotic prophylaxis.

Pregnancy
Anesthesia
No office sedation or general anesthetics. No nitrous oxide, chronic
exposure increases spontaneous abortions. Local anesthesia fine.
Acetaminophen drug of choice. Therapeutic short-term meperidine (Demerol)
And fentanyl fine. Oxy/hydrocodone not bad. Propoxyphene not good.
Codeine causes congenital anomalies.

Pregnancy
Analgesia (continued)
Aspirin causes anemia, antepartum or postpartum hemorrhage and intracranial
fetal hemorrhage. Pentazocine (Talwin) no congenital defects, but may cause
severe neonatal respiratory depression, avoid giving near term. Avoid NSAIDs
during third trimester and new research suggests throughout pregnancy.
Antibiotics
Penicillins, cephalosporins, erythromycin and clindamyacin not teratogenic.
Don’t use aminoglycosides, tetracycline, metronidazole and sulfonamides.
Corticosteroids
Increases risk of maternal infection and neonatal sepsis, don’t use.
Anticholinergics
Don’t use Pro-Banthine.
Muscle Relaxants
Cyclobenzaprine (Flexeril) one of only possible drugs to use.
 Lactation
Amount of drug in breast milk usually not more than 1-2% maternal dose.
Don’t use aspirin, tetracycline, barbiturates or benzodiazepines. No consensus
on NSAIDs, oxy/hydrocodone, pentazocine and muscle relaxants, so should
probably avoid. All other drugs commonly used in dentistry ok, codeine ok,
nitrous oxide ok.
Breast feeding instructions. Instruct mother to take drugs just after breast
Feeding and avoid nursing for four or more hours after taking drugs. Pre-op
Pumping and storing milk good.
 Hypothyroid
Untreated very sensitive to sedatives and opiods, use non-narcotic analgesics.
Well controlled, no treatment problems.
 Adrenal Insufficiency
If taking steroids and stressful procedure follow Adrenal Supplementation
Regimen. Steroids also delay healing, cause hypertension, more susceptible
to infection.
 Sickle Cell Anemia
Chronic anemia, increased severity of dentoalveolar infections, osteomyelitis,
 Sickle Cell Anemia (continued)
poor healing.
Increased anesthesia risk so not good candidates for office IV.
sedation or GA. Local anesthesia without vasoconstrictor ok. If
surgery vasoconstrictor ok, aspirate well. Nitrous oxide controversial. If
use must have at least 50% oxygen, watch for diffusion hypoxia.
High dose salicylates cause acidosis. Acetaminophen and small doses of
Codeine drug of choice for pain control.
 G-6-PD Deficiency
G-6-PD MED, drugs usually trigger, mostly sulfonamides, aspirin, phenacetin
and chloramphenicol. Also penicillin, streptomycin and isoniazid.
 Substance Abuse
Alcohol
CNS depressant, increases effects of narcotics, benzodiazepines and
barbiturates.
Chronic users may require greater anesthetic dosages.
Avoid narcotics as often multiple addictions.
Therapeutic doses of acetaminophen mixed with alcohol may cause liver
failure.
Opiods
Medical problems include liver disease and infectious diseases (HIV,
infectious hepatitis and endocarditis). Intravenous drug use history, consider
antibiotic prophylaxis.
High tolerance to pain medication, difficult IV access, behavior problems
and higher dose requirements of anesthetic agents. If on methadone, take
pre-op. Droperidol good for dissociative effect.
Avoid narcotic antagonists, may cause withdrawal (Talwin NX). Can
develop profound hypotension during IV sedation and GA.
Heroin causes xerostomia, cervical caries.
Management principals: Agree prior to procedure on type and time on
narcotics. If cured addict (any substance) avoid narcotics, NSAIDs
preferred.
 Seizure Disorder
Phenytoin, carbemazepine and valpoic acid may cause leukopenia and
thrombocytopenia. Don’t use NSAIDs with these medications. No
propoxyphene or erythromycin with carbemazepine.
 Stroke
Coumadin monitor by PT or INR.
Aspirin or antiplatelet drugs (dipyridamole) monitor by bleeding time: >10
minutes, slightly increased bleeding risk, >20 minutes, significant bleeding risk.
 Arthritis
Aspirin and NSAIDs watch for bleeding.
If rheumatoid arthritis may be taking gold salts, penicillamine,
immunosuppressives or sulfasalazine causing stomatitis.
If stomatitis with bleeding and ulceration watch for blood dyscrasias; anemia,
agranulocytosis or thrombocytopenia.
If steroids may need supplementation.
If joint prosthesis antibiotic prophylaxis.
 Allergies and Congestion
Antihistamines have additive CNS depression with CNS depressants and
alcohol. Increased anticholinergic effects with anticholinergics and other
antihistamines.
Don’t use ketoconazole or erythromycin with antihistamines, can result in liver
damage and cardiac arrhythmias with possible fatalities.
No arrhythmias reported with loratadine (Claritan), fexofenadine (Allegra),
clemastine (Tavist), diphenhydramine (Benadryl), meclizine (Antivert).
Reported problems with cetirizine (Zyrtec).
Decongestants, don’t use local anesthetic with vasoconstrictor, can cause
pressor response. Sedation with CNS depressants and Alcohol. Arrhythmias
with inhalation anesthetics. Medications include Pseudoephedrine (Sudafed,
Actifed Tabs, Afrin Tabs, Triaminic), Oxymetazoline (Afrin) and Ephedrine.
VASOCONSTRICTORS
 Cardiovascular Disease
Healthy adult can receive up to 0.2 mg of epinephrine within 15 minutes. Each c.c.
of 1:100,000 epinephrine contains 0.01 mg. Carpule is 1.8cc, so contains 0.018 mg.
No more than 10 carpules in 15 minutes.
Vasoconstrictor Precautions: With cardiovascular disease limit to 0.04 mg
epinephrine or 0.2 mg levonordefrin in 15 minutes, no more than 2 carpules.
With cardiovascular disease don’t use gingival retraction cord containing
epinephrine. Don’t use 1:50,000 epinephrine. Avoid intraligamental and
intraboney injections with vasoconstrictor local anesthetics.
Avoid vasoconstrictors if taking noncardioselective beta-blockers: Carteolol
(Cartrol, Ocupress), Carvedilol (Coreg), Nadolol (Corgard), Penbutolol (Levatol),
Pindolol (Visken), Propranolol (Inderal) and Timolol (Blocadren). Can use
1:100,000 epinephrine if monitor pre and post injection vital signs, give ½ carpule,
wait 5 minutes, if no change can repeat process. Can use levonordefrin in same
manner.
If patient taking Digoxin (Lanoxin) check with physician prior to using
vasoconstrictor.
 Arrhythmia
Same Vasoconstrictor Precautions except if serious arrhythmia don’t use
vasoconstrictor in local anesthetic.
 Psychiatric Disorders
Potential for hypertensive crisis, myocardial infarction mixing vasoconstrictors
with neuroleptic and heterocyclic medications.
Neuroleptic agents (Antipsychotic drugs) are Chlorpromazine (Thorazine),
Fluphenazine (Permitil), Trifluoperazine (Stelazine), Mesoridazine (Serentil),
Haloperidol (Haldol), Molindone (Moban). If patient is not acutely hypotensive
due to these medications and can avoid intravascular injections, can use
vasoconstrictors in normal dosages. Hypotensive reaction can result from alpha
adrenergic blockade and increase epinephrine results in only beta-2 vasodilative
effects.
Heterocyclics (TCAs) are Amitriptyline (Elavil), Imipramine (Tofranil),
Amoxapine (Asendin), Maprotiline (Ludiomil). If use 1:100,000 epinephrine give
no more than 1/3 maximum dose. Additional dosages after 30 minutes. Don’t use
levonordefrin (Carbocaine with Neocobefrin). Some gingival retraction cords
contain large amounts of epinephrine, don’t use.
 Psychiatric Disorders (continued)
MAO inhibitors are Phenelzine (Nardil), Isocarboxazid (Marplan) and
Tranylcypromine (Parnate). Use local anesthesia without vasoconstrictor
whenever possible. If must use limit to two carpules 1:100,000 epinephrine
within 15 minutes, aspirate.
 Substance Abuse
Stimulants, Cocaine and Methamphetamine
Local anesthesia with vasoconstrictor can cause life threatening arrhythmias and
hypertensive crisis. General anesthetics can be dangerous as are mixing with
psychotropic drugs.
 Miscellaneous Vasoconstrictor Interactions
Don’t use vasoconstrictor if patient has:
1. Pheochromocytoma
2. Hyperthyroid
3. Significant risk with phenylephrine (OTC cold medication)
4. Phentermine (Fastin)
5. Ritalin if patient is hypertensive
Use with caution if:
1. General anesthetic agents; Halothane (Fluothane), Enflurane (Etharane),
Isoflurane (Forane) and Thiopental (Pentothal). Check with anesthesiologist
to see if can use and in what amounts.
2. Guanethidine (Ismelin) and Guanadrel (Hylorel) antihypertensives follow TCA
precautions.
Dental Drug Interactions
 Antibiotics
Penicillin Derivatives: Tetracyclines, erythromycin and clindamycin decrease
effectiveness. Acts synergistically with aminoglycosides. Probenecid will increase
blood levels.
Penicillin, Amoxicillin, Ampicillin, (Augmentin), and (Unasyn)
Macrolide: Decreases action of clindamycin, penicillins and oral contraceptives.
Increases effects of oral anticoagulants and benzodiazepines. Medical; increases
effects of alfentanil, carbamazepine, theophylline, felodipine, triazolam and
ergotamine. Contraindicated with azole antifungals, statins, theophylline,
(Erythromycin and Clarithromycin).
Erythromycin, Clarithromycin (Biaxin) and Azithromycin
(Zithromax)
Lincomycin Derivatives: Decreases activity of erythromycin, increases activity of
nondepolarizing muscle relaxants and hydrocarbon inhalation anesthetics.
Clindamyacin (Cleocin)
Cephalosporins: Decreased bactericidal effects with tetracyclines and erythromycin.
May reduce effectiveness of oral contraceptives. Probenecid decreases elimination.
Cephalexin (Keflex, Keftab) 1st generation
Cefadroxil (Duricef) 1st generation
Cefprozil (Cefzil) 2nd generation
Cefuroxime (Ceftin) 2nd generation
Cefaclor (Ceclor) 2nd generation
Loracarbef (Lorabid) 2nd generation
Cefpodoxime (Vantin) 2nd generation
Cefixime (Suprax) 3rd generation
Tetracycline Derivatives: Decreases effect of penicillin, cephalosporin, oral
contraceptives. Increases oral anticoagulant effect. Absorption reduced by dairy
products, calcium, magnesium or aluminum containing antacids, iron, zinc, and
cimetidine. Outdated drug can cause nephropathy. If give with Methoxyflurane
anesthesia can cause fatal nephrotoxicity.
Tetracycline (Achromycin, Sumycin, Tetracyn)
Minocycline (Minocin)
Doxycycline (Vibramycin)
Tetracycline Periodontal Fibers (Actisite)
 Antifungals
Fluconazole (Diflucan)
Increases coumadin and benzodiazepine activity. Rifampin decreases fluconazole
activity. Arrhythmias possible with antihistamines.
Metronidazole (Flagyl)
None with Disulfiram (Antabuse), causes psychosis.
Clotrimazole (Mycelex Troche)
Increases activity of cyclosporines and sulfonylureas.
 Antivirals
Acyclovir (Zovirax)
Increased CNS side effects with zidovudine (AIDS drug) and probenecid.
 Non-Narcotic Analgesic
Non-Steroidal Anti-inflammatory Drugs (NSAIDs)
Salicylate NSAIDs
Increases bleeding risk with oral anticoagulants. Avoid corticosteroids and
Acetaminophen. Can cause toxicity of Diamox (CNS) and methotrexate (hepatic).
Increased GI bleeding and complaints with alcohol. Increased risk bleeding valproic
acid, dipyridamole. Increased toxicity lithium and zidovudine. Decreased effects
of probenecid and sulfinpyrazone.
Acetylsalicylic Acid (Aspirin, Anacin, Bayer, Bufferin, Ecotrin,
Empirin)
Propionic Acid Derivative NSAIDs
Same as salicylates. Nephrotoxic with acetaminophen. Increased photosensitivity
with tetracycline. Increased toxicity diuretics. Not with methotrexate.
Ketoprofen (Orudis, Oruvail)
Oxaprozin (Daypro)
Naproxen (Aleve, Anaprox, Naprosyn)
Ibuprofen (Advil, Motrin, Midol, Nuprin, Rufen)
Acetic Acid Derivative NSAIDs
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. Not
with lithium or methotrexate.
Acetic Acid Derivative NSAIDs
(continued)
Indomethacin (Indocin)
Diclofenac (Cataflam, Voltaren)
Nabumetone (Relafen)
Etodolac (Lodine)
Sulindac (Clinoril)
Other NSAIDs
Diflunisal (Dolobid)
Decreased effect with antacids. Increased toxicity with digoxin, methotrexate,
anticoagulants, phenytoin and sulfonylureas. Increased toxicity with sulfonamides,
indomethacin, hydrochlorothiazide, lithium and acetaminophen.
Piroxicam (Feldene)
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.
Mefenamic Acid (Ponstel)
Increases effects of oral anticoagulants. Decreased effect with aspirin. None with
corticosteroids, methotrexate and lithium.
Cox-2 Inhibitors
Don’t use with aspirin, increased activity of oral anticoagulants. Other reactions
Same as other NSAIDs.
Celecoxib (Celebrex)
Rofecoxib (Vioxx)
Para-aminophenol Derivates
Barbiturates liver toxicity of high doses of acetaminophen. Therapeutic doses with
alcohol may cause severe hepatic toxicity. Nephrotoxicity with long-term
consumption especially if combined with NSAIDs. Buffered acetaminophen
decreases tetracycline absorption. Cholestyramine reduces effect. Hepatic toxicity
possible with INH and Dilantin.
Acetaminophen (Tylenol, Aspirin Free Anacin, Tempra)
 Non-Narcotic Analgesic?
Tramadol (Ultram)
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.
 Narcotic Analgesic
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
Altered Sensation - Paresthesia
Cardiovascular Drugs
Thiazide diuretics (Hydrodiuril)
Noncardioselective beta blockers (Inderal)
ACE inhibitors (Prinival, Zestril)
Angiotensin II antagonists (Cozaar)
Nitrates (Nitrostat)
Antiarrhythmic agent – (Rythmol, Norpace)
Elevated Cholesterol Drugs
Cholesterol lowering agents – (Lopid), Niacin
Electrolyte Supplement
Potassium chloride
Neurologic Disease Drugs
Anticonvulsant – Dilantin, (Keppra)
Anti-Parkinson agent – (Sinemet)
Antimigraine agent - serotonin agonist (Imitrex)
Ergot Alkaloid – (Cafergot, Wigraine)
Gastrointestinal Disease Drugs
Proton Pump Inhibitor – (Aciphex)
Birth Control and Hormone Replacement Drugs
SERM (Evista)
Allergy and Congestion Drugs
Antihistamines (Claritan)
Diabetes Mellitus Drugs
Insulin (Humulin R)
Osteoporosis Drugs
Calcitonin (Miacalcin Nasal Spray)
Gout Drugs
Uric acid lowering agent (Allopurinol)
Antiglaucoma Agent
Carbonic Anhydrase Inhibitor
Urinary Disorder Drugs
Skeletal muscle relaxant (Baclofen)
Anticholinergic – (Detrol)
Altered Sensation - Paresthesia
Musculoskeletal Disease Drugs
Skeletal Muscle Relaxant – (Flexeril)
Immunosuppressant Drugs
Cyclosporine, Tacrolimus
Drug Abuse Drugs
Smoking deterrent - Nicotine
Autoimmune Disease Drugs
COX-2 inhibitors (Celebrex)
Infectious Disease Drugs
Cephalosporin
Tetracycline derivative
Quinolone
Nitrofurantoin
Protease inhibitor circumoral
Lamivudine
Altered Sensation
Cardiovascular Drugs
Thiazide and potassium sparing diuretic – (Maxzide, Dyazide) burning tongue
Cardiac glycosides (Lanoxin) neuralgia, increased gag reflex
Cardioselective beta blockers (Tenormin) sore throat
Oral anticoagulants (Coumadin) salivary gland pain
Elevated Cholesterol Drugs
Cholesterol lowering agent – (Lopid) hypesthesia, Fenofibrate pain
Electrolyte Supplement
Potassium Chloride throat pain
Antipsychotic Agent
(Seroquel) ear pain
Neurologic Disease Drugs
Acetylcholinesterase inhibitor – (Aricept) toothache
AntiParkinson Agent – (Mirapex) hypesthesia
Gastrointestinal Disease Drugs
Laxative – (Colace) sore throat
Diabetes Mellitus Drugs
Oral antidiabetic agent - Thiazolidinedione derivative neck pain
Neurologic Disease Drugs
Antimigraine - serotonin agonist (Imitrex) jaw, tongue, throat and sinus pain
Autoimmune Disease Drugs
COX-2 inhibitors (Vioxx) hypesthesia
Drug Abuse Drugs
Nicotine burning oral mucosa, sore throat, numbness
Chelating Agent
Penicillamine sore throat
Narcotic Analgesic
Fentanyl dysesthesia
Altered Taste
Cardiovascular Drugs
Calcium channel blockers (Norvasc)
Angiotensin II antagonists (Diovan)
Antiarrhythmic agent – (Rythmol)
Respiratory Drugs
Beta 2 adrenergic agonist (Proventil, Ventalin)
Theophylline derivative (Theo-Dur)
Mast cell stabilizer (Intal, Nasalcrom)
Anticholinergic (Atrovent)
Allergy and Congestion
Antihistamine
Anti-Psychotic Agent
(Seroquel)
Neurologic Drugs
Anticonvulsant – (Dilantin)
Anti-Parkinson agent – (Sinemet)
CNS Stimulant- (Adderall), amphetamine
Acetylcholinesterase inhibitor – (Aricept)
Gastrointestinal Drugs
Proton pump inhibitors (Prilosec)
Laxative – (Colace) bitter taste
Allergy and Congestion Drugs
Antihistamines (Zyrtec)
Diabetes Mellitus Drugs
Biguanides (Glucophage)
Osteoporosis Drugs
Biphosphonate derivatives (Fosamax)
Calcitonin (Miacalcin Nasal Spray)
Gout Drugs
Uric acid lowering agents (Allopurinol)
Antiglaucoma Agent
Carbonic Anhydrase Inhibitor metallic taste
Urinary Disorder Drugs
Skeletal muscle relaxant (Baclofen)
Altered Taste
Obesity Drugs
Anorexant – (Fastin)
Drug Abuse Drugs
Anti-alcohol agent – (Antabuse)
Smoking deterrent – Nicotine (Nicoderm)
Infectious Disease Drugs
Penicillin derivative
Chlorhexidine
Arthralgia - TMJ?
Cardiovascular Drugs
Noncardioselective beta blocker (Visken)
Calcium channel blocker (Adalat, Procardia)
Elevated Cholesterol Drugs
Cholesterol lowering agent – (Questran), Fenofibrate
Anti-Psychotic Agent
(Zyprexa)
Neurologic Disease Drugs
Acetylcholinesterase inhibitor – (Aricept)
Anticonvulsant – (Keppra)
Gastrointestinal Disease Drugs
H-2 antagonists (Zantac)
Proton pump inhibitors (Prilosec)
Birth Control and Hormone Replacement Drugs
SERM (Evista)
Allergy and Congestion Drugs
Antihistamine (Allegra)
Osteoporosis Drugs
Calcitonin (Miacalcin Nasal Spray)
Gout Drugs
Uric acid lowering agent (Allopurinol)
Antiglaucoma Agent
Prostaglandin Agent
Urinary Disease Drugs
Anticholinergic (Detrol)
Cancer Drugs
RBC formation stimulant (Epogen)
Antineoplastic agent – Methotrexate
Immunosuppressant Agent
(Imuran)
Autoimmune Disease Drugs
COX-2 inhibitors (Celebrex)
Chelating Agent
Penicillamine
Arthralgia - TMJ?
Infectious Disease Drugs
Nitrofurantoin
Lamivudine
Vitamin A Derivative
(Accutane)
Myalgia - TMJ?
Cardiovascular Drugs
Beta blocker and thiazide diuretic (Inderide) noncardioselective
Angiotensin II antagonist (Avapro)
Elevated Cholesterol Drugs
Cholesterol lowering agent – (Questran), Fenofibrate
Respiratory Drugs
Beta 2 adrenergic agonist (Serevent)
Leukotriene receptor antagonist (Accolate)
Neurologic Disease Drugs
Anticonvulsant - Neurontin
Antimigraine agent -serotonin agonist (Imitrex)
Acetylcholinesterase inhibitor – (Aricept)
Ergot Alkaloid –(Cafergot, Wigraine)
Thyroid Disease Drugs
Thyroid hormone (Synthroid)
Gastrointestinal Disease Drugs
Proton pump inhibitors (Prevacid)
Antiemetic – (Marinol)
Antacid, Calcium Product – (Tums)
Birth Control and Hormone Replacement Drugs
SERM (Evista)
Allergy and Congestion Drugs
Antihistamines (Tavist)
Osteoporosis Drugs
Biphosphonate derivatives (Fosamax)
Antiglaucoma Agent
Prostaglandin Analogue
Cancer Drugs
Immune Globulin
Immunosuppressant Agent
Cyclosporine, (Imuran), Cyclosporine
Obesity Drugs
Anorexant –(Fastin)
Autoimmune Disease Drugs
COX-2 inhibitors (Celebrex)
]
Myalgia - TMJ?
Infectious Disease Drugs
Lamivudine
Vitamin A Derivative
(Accutane)
Non-Narcotic Analgesic
NSAID – Cox-2 Inhibitor
Tinnitus - TMJ?
Cardiovascular Drugs
Alpha 1 peripheral blocker (Hytrin)
Angiotensin II antagonist (Cozaar)
Antiarrhythmic agent – (Rythmol)
Antiplatelet agent – (Ticlid)
Elevated Cholesterol Drugs
Cholesterol lowering agent – (Questran)
Neurologic Disease Drugs
Anticonvulsant – (Tegretol), barbiturates
Acetylcholinesterase inhibitor – (Aricept)
Gastrointestinal Disease Drugs
Proton pump inhibitors (Prilosec)
Anti-emetic – (Marinol)
Allergy and Congestion Drugs
Antihistamines (Benadryl)
Diabetes Mellitus Drugs
Sulfonylurea (Diabinese)
Antiglaucoma Agent
Carbonic Anhydrase Inhibitor
Urinary Disorder Drugs
Skeletal muscle relaxant (Baclofen)
Autoimmune Disease Drugs
Antimalarial agent – (Plaquenil)
COX-2 inhibitors (Vioxx)
Chelating Agent
Penicillamine
Infectious Disease Drugs
Penicillin derivative
Macrolide antibiotic
Quinolone
Tinnitus - TMJ?
Non-Narcotic Analgesic
NSAIDs
Narcotic Analgesic
Hydrocodone, Codeine, Oxycodone
(Demerol)
Propoxyphene
Narcotic Analgesic
Pentazocine
Headache
Every Drug Except:
Cardiovascular Drugs
Noncardioselective beta blockers (Corgard)
Oral anticoagulant (Coumadin)
Antiplatelet agents (Persantine)
Psychological Disorder Drugs
Tetracycline antidepressant (Remeron)
Neurologic Disease Drugs
Anticonvulsant – (Neurontin)
Birth Control and Hormone Replacement Drugs
Progestogen (Provera)
Diabetes Mellitus Drugs
Biguanides (Glucophage)
Meglitinide (Prandin)
Cancer Drugs
Antiandrogen –(Proscar, Propecia)
Obesity Drugs
Anorexant –(Fastin)
Chelating Agent
Penicillamine
Infectious Disease Drugs
Penicillin derivative
Chlorhexidine
Trimethoprim and Sulfmethoxazole
Non-Narcotic Analgesic
Acetaminophen
Dry Mouth
Cardiovascular Drugs
Thiazide diuretics (Zaroxolyn)
Potassium sparing diuretics (Aldactone)
Beta blockers (Coreg) is noncardioselective, (Tenormin) is cardioselective
Alpha 1 peripheral blockers (Hytrin)
Central acting alpha 2 agonists (Catapres)
ACE inhibitors (Vasotec)
Calcium channel blockers (Cardizem)
Nitrates (Imdur)
Antiarrhythmic agents – (Rythmol, Norpace)
Elevated Cholesterol Drugs
Cholesterol lowering agent - Niacin
Respiratory Disease Drugs
Beta 2 adrenergic agonists (Maxair)
Theophylline derivatives (Theo-Dur)
Corticosteroids (Flonase, Flovent)
Mast cell stabilizers (Intal, Nasalcrom)
Anti-Psychotic Agent
(Zyprexa, Seroquel)
Neurologic Disease Drugs
Anticonvulsant – (Tegretol, Neurontin, Felbatol)
AntiParkinson agent – (Sinemet, Permax, Mirapex, Eldepryl)
AntiParkinson & anticholinergic – (Cogentin)
Acetylcholinesterase inhibitor- (Aricept)
Ergot Alkaloid – (Cafergot, Wigraine)
Gastrointestinal Disease Drugs
Proton pump inhibitors (Prevacid)
GI anticholinergic (Bentyl, Antispas)
Antiemetic –(Reglan, Marinol)
Antidiarrheal – (Lomotil)
Allergy and Congestion Drugs
Antihistamines (Antivert)
Decongestants (Sudafed, Actifed Tabs, Afrin Tabs, Triaminic)
Diabetes Mellitus Drugs
Insulin (Novolin R)
Dry Mouth
Osteoporosis Drugs
Calcitonin (Miacalcin Nasal Spray)
Antiglaucoma Agent
Carbonic Anhydrase Inhibitor
Alpha 2 Adrenergic Agonist
Impotence Drugs
(Viagra)
Urinary Disorder Drugs
Antispasmodic agents (Ditropan, Detrol)
Anticholinergics (Pro-Banthine)
Skeletal muscle relaxants (Baclofen)
Musculoskeletal Disease Drugs
Skeletal Muscle relaxants (Flexeril, Norflex)
Obesity Drugs
Anorexant –(Fastin)
Autoimmune Disease Drugs
COX-2 inhibitors (Celebrex)
Infectious Disease Drugs
Penicillin derivative
Quinolone
Vitamin A Derivative
(Accutane)
Non-Narcotic Analgesic
Propionic acid derivative NSAIDs
(Dolobid) NSAID
(Feldene) NSAID
Non-Narcotic Analgesic?
(Ultram)
Narcotic Analgesic
Hydrocodone, Codeine, Oxycodone
(Demerol)
Fentanyl
Propoxyphene
Pentazocine
Salivation
Neurologic Disease Drugs
AntiParkinson, anticholinergic (Cogentin) increased salivation
Cholinergic – (Mestinon)
Allergy and Congestion Drugs
Antihistamines (Claritan) increased thickness of secretions
Antiglaucoma Agent
Cholinergic Agent excessive salivation
Gingival Reactions - Hyperplasia
Cardiovascular Drugs
Calcium channel blockers (Calan, Isoptin, Verelan)
Neurologic Disease Drugs
Anticonvulsants – (Dilantin, Felbatol)
Birth Control and Hormone Replacement Drugs
Progestogen (Cycrin)
Immunosuppressant Agent
Cyclosporine
Gingival Reactions - Gingivitis
Neurologic Disease Drugs
Anticonvulsants – Neurontin, (Keppra)
Acetylcholinesterase inhibitor – (Aricept)
Gastrointestinal Disease
Proton Pump Inhibitor – (Aciphex)
Birth Control and Hormone Replacement Drugs
Estrogen (Premarin)
Cancer Drugs
Antineoplastic agents - Methotrexate
Gingival Reactions - Bleeding
Cardiovascular Drugs
Potassium sparing diuretics (Dyrenium)
Oral anticoagulant – (Coumadin) (may be overdose)
Antiplatelet agent – (Persantine)
Neurologic Disease Drugs
Anticonvulsant – (Felbatol)
Birth Control and Hormone Replacement Drugs
Estrogen (Estrace)
Progestogen (Cycrin)
Infectious Disease Drugs
Tetracycline derivative
Vitamin A Derivative
(Accutane)
Non-Narcotic Analgesic
NSAID (Feldene)
Fever
Cardiovascular Drugs
Oral anticoagulant (Coumadin)
Respiratory Drugs
Leukotriene Receptor Antagonist (Singulair)
Neurologic Disease Drugs
Anticonvulsants - Dilantin, Barbiturates
AntiParkinson, anticholinergic - Cogentin
Thyroid Disease Drugs
Thyroid hormone (Euthroid, Thyrolar)
Gastrointestinal Disease Drugs
H-2 antagonists (Tagamet)
Proton pump inhibitors (Prilosec)
Anti-inflammatory agent – Sulfasalazine
GI anticholinergic (Librax)
Birth Control and Hormone Replacement Drugs
Progestogen (Depo-Provera)
Gout Drugs
Uric acid lowering agent (Allopurinol)
Antiglaucoma Agent
Carbonic Anhydrase Inhibitor
Urinary Disorder Drugs
Antispasmodic agent (Urispas)
Anticholinergic (Pro-Banthine)
Musculoskeletal Disease
Skeletal Muscle Relaxant – (Soma, Flexiril)
Cancer Drugs
Antineoplastic agent - Methotrexate, Mercaptopurine drug fever
Immune Globulin
Immunosuppressant Agents
(Imuran, Prograf, CellCept)
Chelating Agent
Penicillamine
Fever
Infectious Disease Drugs
Cephalosporin
Tetracycline derivative
Nitrofurantoin
Trimethoprim and Sulfmethoxazole
Lamivudine
Ganciclovir
Chills
Neurologic Disease
AntiParkinson Agent – (Permax)
Gastrointestinal Disease Drugs
Anti-inflammatory agent - Sulfasalazine
Osteoporosis Drugs
Calcitonin (Miacalcin Nasal Spray)
Gout Drugs
Uric acid lowering agent (Allopurinol)
Cancer Drugs
Antineoplastic agent - Methotrexate
Immune Globulin
Autoimmune Disease Drugs
COX-2 inhibitors (Vioxx)
Chelating Agent
Penicillamine
Infectious Disease Drugs
Cephalosporin
Nitrofurantoin
Lamivudine
Blood Dyscrasias
Cardiovascular Drugs
Thiazide diuretics (Hygroton, Thalitone)
Loop diuretics (Lasix)
Potassium sparing diuretics (Dyrenium)
Noncardioselective beta blocker (Inderal)
Central acting alpha 2 agonist (Catapres)
Direct acting vasodilator (Apresoline)
ACE inhibitor (Lotensin)
Antiarrhythmic agent – (Rythmol, Norpace)
Oral anticoagulant (Coumadin)
Antiplatelet agent – (Ticlid)
Elevated Cholesterol Drugs
Cholesterol lowering agent – (Lopid)
Respiratory Disease Drugs
Corticosteroids (Azmacort)
Antipsychotic Agent
(Seroquel)
Neurologic Disease Drugs
Anticonvulsants – (Tegretol, Dilantin, Neurontin, Felbatol), Barbiturates
Anti-Parkinson agent – (Sinemet)
Acetylcholinesterase inhibitor – (Aricept)
Gastrointestinal Disease Drugs
H-2 antagonists (Axid)
Anti-inflammatory agent – Sulfasalazine, (Asacol)
Antiemetic – (Reglan)
Birth Control and Hormone Replacement Drugs
Androgen (Estratest)
Allergy and Congestion Drugs
Acetaminophen (Tylenol)
Diabetes Mellitus Drugs
Sulfonylureas (Amaryl)
Biguanides (Glucophage)
Gout Drugs
Uric acid lowering agent (Allopurinol)
Antiglaucoma Agent
Carbonic Anhydrase Inhibitor
Blood Dyscrasias
Urinary Disease Drugs
Urinary Analgesics – (Pyridium)
Musculoskeletal Disease
Skeletal Muscle Relaxant – (Parafon Forte, Norflex, Skelaxin)
Cancer Drugs
Antineoplastic agent - Hydroxyurea (significant), Methotrexate, Tamoxifen,
Mercaptopurine
Interferon
Immunosuppressant Agent
(Imuran, CellCept, Prograf)
Obesity Drugs
Anorexant (Fastin)
Autoimmune Disease Drugs
Antimalarial agent – (Plaquenil)
COX-2 inhibitors (Celebrex)
Chelating Agent
Penicillamine
Infectious Disease Drugs
Penicillin derivative
Clindamyacin
Tetracycline derivative
Nitrofurantoin
Trimethoprim and Sulfmethoxazole
Acyclovir
(Invirase)
(Videx)
Zidovudine
Lamivudine
Ganciclovir
Non-Narcotic Analgesic
NSAIDs
Acetaminophen
Stomatitis
Cardiovascular Drugs
Antiarrhythmic agent – (Rythmol)
Oral anticoagulant (Coumadin) ulcerative type
Respiratory Disease Drugs
Anticholinergic (Atrovent)
Neurologic Disease Drugs
Anticonvulsant – (Neurontin, Dilantin) oral ulcers, (Tegretol) oral and
throat ulcers
Gout Drugs
Uric acid lowering agent (Allopurinol)
Cancer Drugs
Antineoplastic agent - Hydroxyurea, Methotrexate ulcerative type,
Mercaptopurine
Immunosuppressant Agent
(Imuran) aphthous
Autoimmune Disease Drugs
COX-2 inhibitors (Vioxx) ulcerative type
Infectious Disease Drugs
Penicillin derivative
Tetracycline derivative
Trimethoprim and Sulfmethoxazole
Non-Narcotic Analgesic
NSAIDs Propionic acid derivative
(Clinoril) aphthous stomatitis
(Feldene)
Non-Narcotic Analgesic?
(Ultram)
Glossitis
Elevated Cholesterol Drugs
Cholesterol lowering agent – (Questran)
Neurologic Disease Drugs
Anticonvulsants – (Tegretol, Neurontin)
AntiParkinson, anticholinergic agent – (Cogentin)
Gastrointestinal Disease
Proton pump inhibitor (Prevacid) mucosal atrophy (Aciphex)
Musculoskeletal Disease Drugs
Skeletal Muscle Relaxant – (Soma)
Cancer Drugs
Antineoplastic agent – Methotrexate, Mercaptopurine
Infectious Disease Drugs
Penicillin derivative
Cephalosporin
Acyclovir
Impotence Drugs
(Viagra)
Non-Narcotic Analgesic
(Clinoril)
Pharyngitis
Antipsychotic Agent
(Seroquel)
Neurologic Disease Drugs
Anticonvulsants - (Neurontin)
Birth Control and Hormone Replacement Drugs
SERM (Evista)
Diabetes Mellitus Drugs
Thiazolidinedione derivative
Urinary Disease Drugs
Anticholinergic – (Detrol)
Alpha Adrenergic Blocking Agent – (Flomax)
Immunosuppressant Agent
(CellCept)
Cancer Drugs
Antineoplastic agent - Methotrexate
Sinusitis
Cardiovascular Drugs
Alpha-1 peripheral blocker (Tenex)
Neurologic Disease
Anticonvulsant – (Keppra)
Birth Control and Hormone Replacement Drugs
SERM (Evista)
Diabetic Disease Drugs
Thiazolidinedione derivative
Urinary Disease Drugs
Anticholinergic – (Detrol)
Immunosuppressant Agent
Cyclosporine
Autoimmune Disease Drugs
COX-2 inhibitors (Celebrex)
Impotence Drugs
(Viagra)
Dysphagia
Neurologic Disease Drugs
AntiParkinson, anticholinergic (Cogentin)
Gastrointestinal Disease Drugs
GI anticholinergic (Levbid)
Osteoporosis
Biphosphonate derivative (Fosamax)
Urinary Disorder Drugs
Anticholinergic (Pro-Banthine)
Impotence Drugs
(Viagra)
Infectious Disease Drugs
Tetracycline derivative
Stevens-Johnson Syndrome
Cardiovascular Drugs
Loop diuretics (Demadex)
Neurologic Disease Drugs
Anticonvulsant – (Tegretol, Dilantin), Barbiturates
Gastrointestinal Disease Drugs
Anti-inflammatory agent - Sulfasalazine
Gout Drugs
Uric acid lowering agent (Allopurinol)
Antiglaucoma Agent
Carbonic Anhydrase Inhibitor
Infectious Disease Drugs
Clindamycin
Trimethoprim and Sulfmethoxazole
Fluconazole
Nystatin
(Invirase)
Non-Narcotic Analgesic
NSAIDs
Photophobia
Cardiovascular Drugs
Cardiac Glycosides (Lanoxin)
Neurologic Disease Drugs
AntiParkinson, anticholinergic (Cogentin)
Antimigraine agent - serotonin agonist (Imitrex)
Gastrointestinal Disease Drugs
GI anticholinergic (Bentyl, Antispas)
Antiglaucoma Agent
Cholinergic Agent
Prostaglandin Analogue
Alpha 2 Adrenergic Agent
Urologic Disease Drugs
Anticholinergics (Probanthine)
Autoimmune Disease Drugs
Antimalarial agent – (Plaquenil)
Infectious Disease Drugs
Quinolone
Vitamin A Derivative
(Accutane)
Photosensitivity
Cardiovascular Drugs
Thiazide diuretic (Aquatensin, Enduron)
Cholesterol Lower Agent
Fenofibrate
Gastrointestinal Disease
Proton Pump – (Aciphex)
Cancer Drugs
Antineoplastic agent - Methotrexate
Swelling
Cardiovascular Drugs
Noncardioselective beta blockers (Visken) facial swelling
Angiotensin II antagonist and thiazide diuretic (Hyzaar) facial swelling
ACE inhibitors (Accupril) angioedema
Oral anticoagulants (Coumadin) salivary gland swelling
Respiratory Disease Drugs
Mast cell stabilizer (Intal, Nasalcrom) angioedema, parotid gland swelling
Neurologic Disease Drugs
Anticonvulsant –(Felbatol) buccal mucosa swelling, facial swelling
Acetylcholinesterase inhibitor – (Aricept) tongue edema
Gastrointestinal Disease Drugs
H-2 antagonist (Pepcid) angioedema
Proton Pump Inhibitor – (Aciphex) facial edema, salivary gland
enlargement
Gout Drugs
Uric acid lowering agent (Allopurinol) salivary gland swelling
Musculoskeletal Disease
Skeletal Muscle Relaxant – (Soma) swelling of lips (Flexeril) swelling of
face and lips
Chelating Agent
Penicillamine edema of face
Infectious Disease Drugs
Nitrofurantoin Angioedema
Non-Narcotic Analgesic
Acetic acid derivatives NSAIDS Angioedema
Orthostatic Hypotension
Cardiovascular Drugs
Thiazide diuretics (Aquatensin, Enduron)
Loop diuretics (Lozol)
Alpha 1 peripheral blocker (Cardura)
Central acting alpha 2 agonist (Catapres)
ACE inhibitor (Monopril)
Angiotensin II antagonist (Diovan)
Nitrates (Isordil)
Antiplatelet agent – (Persantine)
Antipsychotic Agent
(Seroquel)
Neurologic Disease Drugs
AntiParkinson agent – (Sinemet, Permax, Eldepryl)
AntiParkinson, anticholinergic (Cogentin)
Ergot Alkaloid – (Germinal, Hydergine)
Gastrointestinal Disease Drugs
GI anticholinergic (Librax)
Anti-Emetic – (Marinol)
Urinary Disease Drugs
Alpha Adrenergic Blocking Agent – (Flomax)
Musculoskeletal Disease Drugs
Skeletal Muscle Relaxant – (Soma, Flexeril)
Narcotic Analgesic
Fentanyl
Discoloration
Cardiovascular Drugs
Direct acting vasodilator (Apresoline) facial flushing
Respiratory Disease Drugs
Beta 2 adrenergic agent (Proventil, Ventalin) facial flushing, tooth
discoloration
Osteoporosis Drugs
Calcitonin (Miacalcin Nasal Spray) facial flushing
Musculoskeletal Disease
Skeletal Muscle Relaxant – (Soma, Parafon Forte, Flexeril, Norflex) facial
flushing
Anemia Drugs
Iron Salt – Ferrous Sulfate (extrinsic stain on teeth with liquid form)
Cancer Drugs
Immune Globulin facial flushing
Antineoplastic agent - Hydroxyurea facial erythema
Autoimmune Disease Drugs
Antimalarial agent – (Plaquenil) discoloration of oral mucosa
Chelating Agent
Penicillamine white spots on lips or mouth
Infectious Disease Drugs
Penicillin derivative black hairy tongue
Tetracycline derivative tongue discoloration
Chlorhexidine staining teeth, tongue, restorations
Nitrofurantoin brown discoloration of saliva, tooth staining
Non-Narcotic Analgesic
NSAIDs (Clinoril) white spots mouth or lips
Miscellaneous Reactions
Cardiovascular Drugs
Thiazide and potassium sparing diuretic (Maxzide, Dyazide) angular
cheilitis
Neurologic Disease Drugs
Anticonvulsant –(Dilantin) Lupus Erythematosus
Barbiturates Laryngospasm
Acetylcholinesterase inhibitor – (Aricept) coated tongue
Ergot Alkaloid (Germinal, Hydergine) Sublingual irritation
Autoimmune Disease Drugs
Antimalarial agent –(Plaquenil) lichenoid lesions
COX-2 inhibitors (Vioxx) dry sockets
Respiratory Disease Drugs
Corticosteroids (Nasalide) candidiasis
Gastrointestinal Disease Drugs
Proton pump inhibitor (Prilosec) candidiasis
Diabetes Mellitus Drugs
Thiazolidinedione derivative - infection
Birth Control and Hormone Replacement Drugs
Estrogen (Estrace) dry sockets
Urinary Disease Drugs
Alpha Adrenergic Blocking Agent – (Flomax) tooth disorders
Immunosuppressant Agent
Cyclosporine candidiasis
Infectious Disease Drugs
Penicillin derivative candidiasis
Macrolide antibiotic candidiasis
Clindamyacin candidiasis
Cephalosporin candidiasis, pseudomembranous colitis
Tetracycline derivative hypertrophy tongue papilla, lichenoid reaction,
candidiasis, erythema multiforme
Chlorhexidine mucosal desquamation and irritation, transient parotitis,
increased calculus formation
Quinolone candidiasis
Trimethoprim and Sulfmethoxazole pseudomembranous colitis, erythema
multiforme
Miscellaneous Reactions
Vitamin A Derivative
(Accutane) cheilitis
Non-Narcotic Analgesic
Salicylate NSAIDs increased oral bleeding
NSAID (Daypro) Erythema multiforme
Narcotic Analgesic
Fentanyl laryngospasm
Bright Orange Tongue
Cardiovascular Drugs
Thiazide and potassium sparing diuretic - Maxzide, Dyazide
Obesity Agonist
Creamsicle!
Drugs Used in Dentistry
Pain Medications
Nonnarcotic:
Acetaminophen (Tylenol)
Aminosalicylate Sodium (Sodium P.A.S)-NSAID
Aspirin
Celecoxib (Celebrex)-NSAID, COX 2 Inhibitor
Choline Magnesium Trisalicylate (Trilisate)-NSAID
Choline Salicylate (Arthropan)-NSAID
Diclofenac (Cataflam, Voltaren, Voltaren SR, Apo-Diclo, NovoDifenac, Novo-Difenac SR, Nu-Diclo)-NSAID
Diflunisal (Dolobid)-NSAID
Etodolac (Lodine)-NSAID
Fenoprofen (Nalfon, Nalfon 200)-NSAID
Flurbiprofen (Anasaid, Froben, Apo-Flurbiprofen, NovoFlurprofen, Nu-Flurbiprofen)-NSAID
Ibuprofen (Motrin, Dolgesic, Ibu, Ibu-4, Ibuprohm, Ibu-Tab,
Motrin, Rufen, Apo-Ibuprofen, Novo-Profen, Nu-Ibuprofen,
Advil, Bayer Select Ibuprofen, Cramp End, Excedrin IB,
Genpril, Haltran, Ibu-200, Ibuprin, Ibuprohm, Ibu-Tab,
Medipren, Midol, Motrin, Nuprin, Pamprin, Q-profen,
Trendar)-NSAID
Indomethacin (Indocin, Apo-Indomethacin, Novo-Methacin, NuIndo)-NSAID
Ketoprofen (Orudis, Orudis-E, Oruvail, Rhondis-EC, Rhodis, ApoKeto-E, Actron, Orudis KT)-NSAID
Ketorolac (Toradol)-NSAID
Magnesium Salicylate (Doan’s, Magan, Mobidin)-NSAID
Meclofenamate (Meclomen)-NSAID
Mefenamic Acid (Ponstel, Ponstan)-NSAID
Nabumetone (Relafen)-NSAID
Naproxen (Aleve, Anaprox, Anaprox DS, Synflex, Naprosyn,
Naxen, Apo-Naproxen, Novo-Naprox, Nu-Naprox)-NSAID
Oxaprozin (Daypro)-NSAID
Oxyphenbutazone-NSAID
Phenylbutazone (Apo-phenylbutazone, Butazolidin)
Piroxicam (Feldene, Apo-Piroxicam, Novo-Pirocam, Nu-Pirox,
PMS-Piroxicam )-NSAID
Rofecoxib (Vioxx)-NSAID, COX-2 Inhibitor
Salsalate(Anaflex, Disalcid)-NSAID
Sulindac (Clinoril)-NSAID
Tolmetin (Tolectin)-NSAID
Narcotic
Codeine
Aspirin and Codeine (Empirin with Codeine)
Acetaminophen and Codeine (Capital with Codeine, Tylenol with
Codeine, Phenaphen with Codeine)
Acetaminophen and Hydrocodone (Vicodin, Vicodin ES, CoGesic,
Loratab, Allay, Anolar DH5, Bancap-HC, Dolacet, Dolagesic,
Hycomed, Hycopap, Hydroset, Hydrogesic, Lorcet-HD,
Margesic-H, Panlor, Polygesic, Stagesic, T-Gesic, Ugesic,
Vendone, Zydone, Anexia 5/500, Duocet, Hy-phen, Oncet,
Panacet 5/500, Vanacet)
Butorphanol (Stadol)
Oxycodone (Roxicodone, Roxicodone Intensol, Supeudol,
OxyContin)
Aspirin and Oxycodone (Codoxy, Percodan, Roxiprin, PercodanDemi)
Acetaminophen and Oxycodone (Endocet, Percocet, Roxicet,
,Roxilox, Tylox, Roxicet 5/500, Percocet-Demi)
Codeine with Aspirin, Caffeine and Butalbital (Ascomp with
Codeine, Butalbital Compound with Codeine, Butinal with
Codeine, Fiorinol #3, Idenal with Codeine, Isollyl with Codeine,
Fiorinal-C1/2 or C1/4, Tecnal-C1/2 or C1/4
Dihydrocodeine with Acetaminophen and Caffeine (DHC Plus)
Dihydrocodeine with Aspirin and Caffeine (Synalgos DC)
Hydromorphone (Dilaudid, Hydrostat IR; PMS Hydromorphone)
Ibuprofen and Hydrocodone (Vicoprofen)
Meperidine (Demerol)
Morphine (MSIR, M-Eslon, Rescudose, Roxanol UD, NS/L
Concentrate, OMS Concentrate, Roxanol, Roxanol 100, Statex
drops, Statex, Astramorph PF, Duramorph, Epimorph,
Morphine Extra-Forte, Morphine Forte, Morphine H.P, MS/S,
RMS Inserts)
Nalbuphine (Nubain)
Pentazocine (Talwin NX)
Pentazocine with Acetaminophen (Talacen)
Pentazocine with Aspirin (Talwin Compound)
Propoxyphene (Darvon)
Aspirin and Propoxyphene (Darvon-P with ASA
Propoxyphene with Aspirin and Caffeine (Darvon Compound-65,
PC-Cap, Propoxyphene Compound-65)
Acetaminophen and Propoxyphene (E-Lor, Wygesic, Darvocet-N50, Darvocet-N-100)
Antibiotics
Amoxicillin(Amoxil, Polymox, Trimox)
Amoxicillin and clavulanate, (Augmentin)
Ampicillin (Amcill, Omnipen, Polycillin, Principen)
Azithromycin (Zithromax)
Bacampicillin (Spectrobid)
Carbenicillin (Geocillin)
Cefaclor (Ceclor)
Cefadroxil (Duricef, Ultracef)
Cefixime (Suprax)
Cefuroxime (Ceftin)
Cephalexin (Biocef, Cefanex, Keflet, Keflex, Keftab)
Cephadrine (Anspor,Velosef)
Loracarbef (Lorabid)
Chlorhexidine (Peridex, PerioGard)
Ciprofloxacin (Cipro)
Clarithromycin (Biaxin)
Clindamycin (Clecin, Cleocin)
Cloxacillin (Cloxapen, Tegopen)
Dicloxacillin (Dycill, Dynapen, Pathocil)
Dirithromyacin (DynaBac)
Doxycycline (Vibramyacin, Dorys, Doxycin, Doxylin, Monodox,
Vibra-tabs, Atridox, Peroistat)
Doxycycline (Periostat, Atridox)
Erythromycin (Erythrocin, E-Mycin, Ery-Tab, E.E.S., Pediamycin,
Eryped, Erythro, Erypar, Erythrocin, Erythrocot)
Fluoroquinolones (Cipro)
Metronidazole (Flagyl, MetroGel, Protostat)
Minocycline (Dynacin, Minocin)
Nafcillin (Unipen)
Oxacillin (Bactocill, Prostaphin)
Penicillin V Potassium (Pen VK, V-Cillin K,Veetids, Betapen-K,
Pen-Vee K, Phenoxymethyl-penicillin)
Penicillin G benzathine (BiCillin)
Tetracycline (Achromycin, Sumycin, Tetracyn)
Tetracycline fiber (Actisite)
Antifungals
Amphotericin B (Fungizone, Lotrimin, Mycelex, Myclo)
Clotrimazole (Mycelex) troches
Fluconazole (Diflucan)
Itraconazole (Sporanox)
Ketoconazole (Nizoral)
Nystatin (Mycostatin, Mycogen, Akorazol, Nilstat, Nystex,
Nodostine, Nyaderm) ointment or cream
Nystatin (Mycostatin) oral suspension
Nystatin (Mycostatin) pastilles
Nystatin (Mycostatin) powder
Nystatin and Triamcinolone (Mycolog) cream
Antiviral
Acyclovir (Zovirax, Avirax)
Foscarnet (Foscavir)
Imiquimod (Aldara)
Nelfinavir (Viracept)
Penciclovir (Denavir)
Vidarabine (Vira-A)
Steroids
Betamethasone (Ceestone,Cel-U-Jec, Betnelan)
Cortisone (Cortone)
Dexamethasone (Decadron, Cortastat L.A., Dalalone D.P.,
Decaject, Dexasone, Dexasone L.A., Dexone, Dexone L.A.,
Hexadrol, Solurex, Solurex L.A.)
Fluocinonide (Lidex ointment mixed 50/50 with Orabase)
Fludrocortisone (Florinef)
Hydrocortisone (Cortisol, Cortef, Hydrocortone, Solu-Cortef)
Methylprednisolone (Medrol, A-methaPred, depMedalone-40,
depMedalone-80, Depoject, Depo-Medrol, Depopred-40,
Depopred 80, Duralone-40, Duralone-80, M-Prednisol-40, MPrednisol-80, Medralone 40, Medralone 80, Medrol, SoluMedrol)
Prednisolone (Delta-Cortef, Hydeltrasol, Key-Pred 25, Key-Pred
50, Key-Pred-SP, Pediapred, Predalone-50, Predcor-50,
Prednisol TBA, Prelone)
Prednisone (Meticorten, Deltasone, Orasone, Panasol-S,
Prednicen-M, Prednisone Intensol Concentrate, Strerapred,
Apo-Prednisone, Jaa-Prednisone, Novo-Prednisone, Wimpred)
Triamcinolone (Aristocort, Kenalog in Orabase, Amacort,
Aristocorte Forte, Aristocorte Intralesional, Aristospan Intraarticular, Atolone, Clinacort, Kenacort, Kenaject-40, Kenalog-10,
Kenalog-40, Tac-3, Tac-40, Triam Forte, Tgriam-A, Triamonide
40, Tri-Kort, Trilog, Trilone, Tristoject)
Sedatives, General Anesthesia
Alfentanil (Alfenta)
Alprazolam (Xanax, Alpo-Alpraz, Novo-Alprazol, Nu-Alpraz)
Amitriptyline (Elavil)
Amobarbital (Amaytal sterile solution)
Aprobarbital (Alurate)
Bromazepam (Lectopam)
Buspirone (BuSpar)
Butabarbital (Busodium, Butalan, Butisol)
Butorphanol (Stadol)
Chlordiazepoxide (Libritabs, Librium, Apo-Chlordiazepoxide,
Novopoxide, Solium)
Chloral hydrate (Novo-Chlohydrate, Aquachloral Supprettes)
Clonazepam (Klonopin, Rivotril, Syn-Clonazepam)
Clorazepate (Gen-Xene, Tranxene-T-Tabs, Tranxene-SD, ApoClorazepate, Novo-Clopate, Tranxene)
Desflurane (Suprane)
Diazepam (Valium, Apo-Diazepam, Novodipam, Valium, Vivol)
Diphenydramine (Benadryl)
Droperidol (Inapsine)
Enflurane (Ethrane)-Halogenated hydrocarbons
Estazolam (ProSom)
Ethchlorvynol (Placidyl)
Etomidate (Amidate)
Flurazepam (Dalmane, Apo-Flurazepam, Novoflupam
Fentanyl (Sublimaze)
Halazepam (Paxipam)
Halothane (Fluothane Somnothane)-Halogenated hydrocarbons
Hydroxyzine (Vistaril)
Isoflurane (Forane)-Halogenated hydrocarbons
Ketamine (Ketalar)
Ketazolam (Loftran)
Lorazepam (Ativan, Lorazepam Intensol Concentrated Solution,
Apo-Lorazepam, Novo-Lorazem, Nu-Loraz)
Meperidine (Demerol)
Mephobarbital (Mebaral)
Meprobamate (Equanil, Miltown, Trancot, Apo-Meprobamate,
Meprospan 200, Meprospan 400)
Methohexital sodium (Brevital. Brietal)
Methoxyflurane (Penthrane) –Halogenated ether
Midazolam (Versed)
Morphine (Astramorph PF, Duramorph, Epimorph, Morphine
Forte, Morphine Extra Forte, Morphine HP)
Nalbuphine (Nubain)
Nitrazrepam (Mogadon)
Nitrous Oxide
Oxazepram (Serax,Apo-Oxazepam, Novoxapam)
Pentazocine (Talwin)
Pentobarbital (Nembutal, Novopentobarb, NovoRectal)
Phenobarbital (Barbita, Solfoton, Luminal)
Prazepam (Centrax)
Promethazine (Phenergan)
Propofol (Diprivan)
Quazepam (Doral)
Remifentanil (Ultiva)
Secobarbital (Seconal, Novosecobarb)
Sevoflurane (Ultane)
Sufentanil (Sufenta)
Temazepam (Restoril)
Triazolam (Halcion, Apo-Triazo, Gen-Triazolam, NovoTriolam,
Nu-Triazo)
Thiopental sodium (Pentothal)
Zolpidem (Ambien)
Muscle Relaxants
Chlorzoxazone (Parafon Forte DSC)
Cyclobenzaprine (Flexeril, Cycloflex))
Methocarbamol (Robaxin)
Orphenadrine (Norgesic Forte)
Local Anesthesia
Articaine and Epinephrine (Septocaine, Septanest, Ultracaine DS)
Benzocaine-topical anesthetic
Benzocaine and menthol (Chloraseptic)-lozenges
Benzocaine and phenol
Benzocaine, butamben and tetracaine
Bupivacine (Marcaine, Sensorcaine MPF)
Bupivacaine and Epinephrine (Marcaine with Epinephrine, Sensorcaine)
Chloroprocaine (Nesacaine)
Dyclonine (Sucrets)-lozenges
Etidocaine with Epinephrine (Duranest with Epinephrine)
Levobupivacaine (Chirocaine)
Lidocaine (Alphacaine, Xylocaine)
Lidocaine and Epinephrine (Alphacaine with Epinephrine, Lignospan
Standard, Lignospan Forte, Octocaine with Epinephrine, Octocaine 50,
Octocaine 100, Xylocaine with Epinephrine)
Lidocaine Transoral (Dentipatch)
Lidocaine Viscous
Mepivacaine (Arestocaine, Carbocaine 3%, Isocaine 3%, Polocaine 3%,
Scandonest 3% plain)
Mepivacaine and Levonordefrin (Arestocaine witb Levonordefrine,
Carbocaine 2% with NeoCobefrin, Isocaine 2% with Levonordefrine,
Polocaine 2% with Levonordefrin, Scandonest with Levonordefrine)
Prilocaine (Citanest Plain 4%)
Prilocaine with Epinephrine (Citanest Forte with Epinephrine)
Ropivacaine (Naropin)
Tetracaine-aerosol
Tetracaine (Pontocaine, Viractin)
Tetracaine and Dextrose (Pontocaine with Dextrose injection)
Others
Naloxone hydrochloride (Narcan)
Flumazenil (Romazicon)
Diphenydramine (Benadryl)
Physostigmine (Antilirium)
Propantheline (Pro-Banthine)
Sodium Fluoride
Thera-Flur-N or Prevident
Stannous Fluoride
Gel-Kam
Revive-remineralizing agent
Sodium Carboxymethylcellulose
Xero-Lube
Salagen
Antiemetic
Chlorpromazine (Thorazine)
Dimenhydrinate (Dramamine)
Droperidol (Inapsine)
Hydroxyzine (Vistaril, Atarax)
Meclizine (Bonine)
Promethazine (Phenergan)
Prochlorperazine (Compazine)
Trimethobenzamide (Tigan)
Decongestants
Oxymetazoline (Afrin)
Phenylephrine (Neo-Synephrine)
Pseudoephedrine (Sudafed)
Antihistamines
Nonsedative:
Loratadine (Claritin)
Fexofenadine (Allegra)
Sedating:
Cetirizine (Zyrtec)
Chlorpheniramine (ChlorTrimeton)
Clemastine fumarate (Tavist)
Hydroxyzine (Atarax, Vistaril)
Triplennamine (PBZ)