Adverse drug interactions in dental practice: Interactions associated withanalgesics - Part III in a series

Background-Numerous reports of drug interactions exist, yet not all are val id in or pertinent to dentistry. This article provides an overview of drug interactions with analgesics and identifies those that are clinically relev ant. Methods. The author reviewed reports of drug interactions involving nonster oidal anti-inflammatory drugs, or NSAIDs (including aspirin), acetaminophen and opioids to determine the interactions' validity and clinical relevance . Consistent with the practice followed in other articles in this series, t he author determined the significance of the proposed interaction by gaugin g its reported severity and the quality of the documentation. Results and Conclusions. NSAIDs should not be taken by patients taking high -dose methotrexate, anticoagulants or alcohol. They should be avoided in el derly or renally impaired patients taking digoxin, and avoided over the lon g term in those taking other NSAIDs. It is possible that NSAIDs should not be given to patients taking lithium, but future studies should be conducted to confirm this. Use of NSAIDs likely is appropriate in the short term wit h patients taking antihypertensives, unless they have severe congestive hea rt disease. Aspirin should not be given to patients taking oral hypoglycemi cs, valproic acid or carbonic anhydrase inhibitors. Acetaminophen may be gi ven in the short term to any patient with a healthy liver, but it should no t be given to a patient who has stopped drinking alcohol after chronic inta ke. Opioids should not be combined with alcohol, and meperidine must be avo ided in the patient who has taken monoamine oxidase inhibitors in the previ ous 14 days. Clinical Implications. Drug interactions with analgesics are often reported , but only a small number have clinical relevance in dentistry. Awareness o f the significance of these interactions will allow dentists to prescribe a nalgesics optimally and minimize the potential for adverse reactions.