Beta-adrenergic blocking agents and dental vasoconstrictors.

Abstract

A clinically significant interaction between epinephrine or levonordefrin with nonselective beta-adrenergic blocking agents, although apparently rare in the dental setting, is potentially serious and can lead to significant hypertension with a concomitant reflex bradycardia. Based on the results of epinephrine infusion studies, the severity of the interaction seems dose related; small epinephrine doses cause less of a pressor response than larger doses. The interaction can be seen after intraoral submucosal injections but is generally of a smaller magnitude, at least with only 1 or 2 cartridges of lidocaine plus 1:100,000 epinephrine. However as demonstrated by 1 case report, some individuals are hypersensitive to this interaction. Inadvertent intravascular injections of local anesthetic plus vasoconstrictor and the use of high doses of vasoconstrictor are likely to result in a more pronounced response. Patients with significant cardiovascular disease may be especially vulnerable to the most serious sequelae resulting from the pressor reactions of the drug combination.

• Authors: Elliot V Hersh, Helen Giannakopoulos
• Journal: Dental clinics of North America (Dent Clin North Am) Vol. 54 Issue 4 Pg. 687-96 (Oct 2010) ISSN: 1558-0512 [Electronic] United States
• PMID: 20831932 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2010 Elsevier Inc. All rights reserved.

Chemical References

• Adrenergic beta-Antagonists
• Anesthetics, Local
• Vasoconstrictor Agents
• Propranolol
• Metoprolol
• Nordefrin
• Epinephrine

Topics

• Adrenergic beta-Antagonists (adverse effects, pharmacology)
• Anesthesia, Dental (adverse effects)
• Anesthetics, Local (adverse effects)
• Bradycardia (chemically induced)
• Drug Interactions
• Epinephrine (adverse effects)
• Humans
• Hypertension (chemically induced)
• Metoprolol (adverse effects)
• Nordefrin (adverse effects)
• Propranolol (adverse effects)
• Vasoconstrictor Agents (adverse effects)