1. Prescriptions in Oral medicine
DEPARTMENT OF ORAL MEDICINE & RADIOLOGY
Dentistry Explorer
2. What is prescription ?
An official piece of paper on which a doctor
writes the type of medication you should have.
Oxford Advanced Learner’s Dictionary
6th edition
Dentistry Explorer
3. What is drug ?
Drug is a substance or
product that is used or is
intended to be used to
modify or explore
physiological systems or
pathological states for the
benefit of the recipient .
WHO (1966)
Dentistry Explorer
4. Drug nomenclature
A drug generally has three categories of names :
1. Chemical name :It describes the substance chemically.
e.g. 2-Diethylamino 2,6-acetoxylidide hydrochloride for
Lidocaine (Lignocaine)
2. Non-proprietary name :It is the name accepted by competent
scientific body such as United States Adopted Name (USAN).
e.g. Lidocaine
3. Proprietary (Brand) name :It is the name assigned by the
manufacturers.
e.g. Xylocaine, Gesicain,Lignospan
Dentistry Explorer
5. Routes of drug administration :
Most drugs can be administered by a variety of
routes. The choice of appropriate route in a given situation
depends both on drug as well as patient related factors.
Factors governing the choice of route :
1. Physical and chemical properties of the drug ( solid /
liquid / gas ; solubility , stability , pH , irritancy )
2. Site of desired action :
Localized and approachable or generalized and not
approachable.
Dentistry Explorer
6. Routes of drug administration contd…
3. Rate and extent of absorption of the drug from
different routes.
4. Effect of digestive juices and first pass metabolism
on the drug.
5. Rapidity with which the response is desired
( routine treatment or emergency ).
6. Accuracy of dosage required ( i.v. and inhalation can
provide fine tuning ).
7. Condition of the patient ( unconscious , vomiting ).
Dentistry Explorer
7. Routes of drug administration contd…
1. Local routes :
These routes can only be used for localized lesions at accessible sites.
a. Topical : This refers to external application of the drug to the surface for
localized action. It is often more convenient as well as encouraging to the
patient.
e.g. Skin – as ointment, cream , powder, spray , etc.
Mucous membrane - as paints, lozenges, mouth washes, gargles, etc.
b. Deeper tissues : Certain deep areas can be approached by using a syringe and
needle, but the drug should be such that systemic absorption is slow .
e.g. Intra – articular injection ( hydrocortisone acetate )
Intrathecal injection ( lidocaine, amphoterecin B )
Retrobulbar injection ( hydrocortisone acetate ).
c. Arterial supply : Close intra-arterial injection is used for contrast media in
angiography.
Dentistry Explorer
8. Routes of drug administration contd…
2. Systemic routes :
The drug administered through systemic routes is intended to be absorbed into blood
and disributed all over, including the site of action, through circulation.
a. Oral :
e.g. Solid dosage forms – tablets, capsules
Liquid dosage forms – syrups, emulsions.
b. Sublingual or Buccal :
e.g. Nitroglycerine, Clonidine.
c. Rectal :
e.g. Diazepam, Indomethacin.
d. Cutaneous :Highly lipid soluble drugs as ointments.
e.g. Transdermal therapeutic systems – Nitroglycerine, insulin.
e. Inhalation :
e.g. General Anaesthetics.
f. Nasal :
e.g. Desmopressin. Dentistry Explorer
9. Routes of drugs administration contd…
g. Parenteral : This refers to the administration by injection which takes the
drug directly into the tissue fluid or blood without having to cross the
intestinal mucosa.
i. Subcutaneous ( s.c.) : The drug is deposited in the loose subcutaneous
tissue which is richly supplied by nerves ( irritant drugs can be injected )
but less vascular ( absorption is slower )
e.g. Japanese Encephalitis, Rabies vaccine.
ii. Intramuscular ( i.m.) : The drug is injected in one of the large skeletal
muscles like Deltoid, Triceps.
e.g. Measles vaccine, Tetanus Toxoid vaccine.
iii. Intravenous ( i.v. ) : The drug is injected as a bolus or infused slowly
over hours in one of the superficial veins.
e.g. 0.9 % normal saline, 5 % dextrose.
iv. Intradermal ( i.d ) : The drug is injected into the skin raising a bleb.
e.g. BCG vaccine.
Dentistry Explorer
10. Oral medicine is a specialty within dentistry
that focus on the diagnosis and management of
complex diagnostic and medical disorders affecting
the mouth and jaws.
Burket’s Oral medicine -11th Edition
Clinicians with advanced training in this
discipline manage oral mucosal disease, salivary
gland disorders, facial pain syndromes and also
provide dental care for patients with complicating
medical disease.
Dentistry Explorer
11. Oral mucosal diseases
1. Ulcerative, Vesicular, and Bullous Lesions :
a. Acute multiple lesions :
• Herpes Simplex Virus Infection
• Varicella-Zoster Virus Infection
• Cytomegalovirus Infection
• Coxackievirus Infection
• Necrotizing Ulcerative gingivitis and Periodontitis
• Erythema Multiforme
• Stevens Johnson Syndrome and Toxic Epidermal
Necrolysis ( Lyell disease )
• Oral Hypersensitivity Reactions
Dentistry Explorer
13. Oral mucosal diseases
c. Chronic Multiple Lesions :
• Pemphigus Vulgaris
• Paraneoplastic Pemphigus
• Pemphigus Vegetans
• Subepithelial Bullous Dermatitis
• Bullous Pemphigoid
• Mucous Membrane Pemphigoid
( Cisatrical Pemphigoid )
• Linear IgA Disease
• Epidermolysis Bullosa Aquisita
• Chronic Bullous Disease of Childhood
Dentistry Explorer
14. Oral mucosal diseases
d. Single Ulcers :
• Traumatic Injuries Causing Solitary Ulcerations
• Traumatic Ulcerative Granuloma
( Eosinophilic Ulcer of Tongue )
• Histoplasmosis
• Blastomycosis
• Mucormycosis ( Phycomycosis )
Dentistry Explorer
15. Oral mucosal diseases
2. Red and White Lesions of the Oral Mucosa :
a. Red and White Tissue Reactions :
b. Infectious Diseases :
• Oral Candidiasis
• Hairy Leukoplakia
c. Premalignant Lesions :
• Oral Leukoplakia and Erythroplakia
• Oral Submucous Fibrosis
Dentistry Explorer
16. Oral mucosal diseases
d. Immunopathologic Diseases :
• Oral Lichen Planus
• Drug-Induced Lichenoid Reactions
• Lichenoid Reactions of Graft-Versus-Host Disease
• Lupus Erythematosus
e. Allergic Reactions :
• Lichenoid Contact Reactions
• Reactions To Dentifrice and Chlorhexidine
Dentistry Explorer
17. Oral mucosal diseases
f. Toxic Reactions :
• Reactions to Smokeless Tobacco
• Smoker’s Palate
g. Reactions to Mechanical Trauma :
• Morsicatio
h. Other Red and white Lesions :
• Benign Migratory Glossitis ( Geographic Tongue )
• Leukoedema
• White Sponge Nevus
• Hairy Tongue Dentistry Explorer
18. Oral mucosal diseases
3. Pigmented Lesions of the Oral Mucosa :
a. Endogenous Pigmentation :
b. Focal Melanotic Pigmentation :
• Freckle / Ephelis
• Oral / Labial Melanotic Macule
• Oral Melanoacanthoma
• Melanocytic Nevus
• Malignant Melanoma
Dentistry Explorer
21. Oral mucosal diseases
e. Idiopathic Pigmentation :
• Laugier-Hunziker Pigmentation
f. Treatment of Mucocutaneous Melanosis :
g. Depigmentation
• Vitiligo
h. Hemoglobin and Iron-Associated Pigmentation :
• Ecchymosis
• Purpura / Petechiae
• Hemochromatosis
Dentistry Explorer
22. Benign lesions of oral cavity
1. Variants of normal :
2. Benign Soft Tissue Lesions :
• Inflammatory / Reactive Hyperplasia of Soft Tissue
• Benign Soft Tissue Tumors
Dentistry Explorer
23. Benign lesions of oral cavity
3. Benign Lesions of Bone :
• Benign Fibro-osseous Lesions
• Fibrous Dysplasia
• Langerhans’ Cell Histiocytosis
• Giant Cell Lesions of Bone
• Paget’s Disease of Bone
• Cysts of Jaws and Adjacent Soft Tissues
• Odontogenic Tumors
• Benign Non-odontogenic Tumors of the Jaw
Dentistry Explorer
24. Oral cancers
1. Squamous Cell Carcinoma :
2. Other Head and Neck Cancers :
• Malignant Tumors of Salivary Glands
• Basal Cell Carcinoma
• Malignant Melanoma
3. Pretreatment Oral and Dental Assessment
4. Complications of Cancer Treatment :
• Mucositis
• Hyposalivation
5. Management of Pain in Orofacial Cancer
Dentistry Explorer
29. Abbreviations
Once daily o.d. omni die
Twice daily b.d. /b.i.d. bis in die
Three times daily t.d.s./t.i.d. ter in die
Four times daily q.i.d./q.d.s.quater die
sumendus
At bed time h.s. hora somni
Dentistry Explorer
30. Abbreviations contd...
Orally p.o. per os
Intramuscular i.m.
Intravenous i.v.
Subcutaneous s.c.
Rectally p.r. per rectus
As required s.o.s. si opus sit
Dentistry Explorer
31. Highlights :
Drugs :
1. Mechanism of action
2. Generic name
3. Brand name
4. Indication
5. Administration
6. Prescription / OTC
7. Dosage
8. Duration
9. Contraindication
10. Common side effects
11. Unusual but important side effects
12. Drug interactions
13. Monitoring
Dentistry Explorer
33. Lidocaine
Mechanism of action :
• Blocks nerve conduction by decreasing the
entry of Sodium ions during upstroke of action
potential.
Dentistry Explorer
34. Topical Analgesic Medications
Generic name-Lidocaine
Brand name- XYLOCAINE, GESICAIN
Indications- Mucosal pain
Superficial facial pain
Administration-Topical patch
Topical gel
Solution
Prescription/OTC-Prescription
Dosage- Patch : apply up to 12 h/d
Gel 2.5% : apply 6-8 times/d
Solution :2% (20 mg/ml) : rinse and expectorate 10 cc q.i.d. s.o.s.
Contraindications-Allergy
Common side effects-Local erythema , edema, burning
Unusual but important side effects- Anaphylaxis
Drug interactions- Acetaminophen
Monitoring-None
Dentistry Explorer
35. Capsaicin
Mechanism of action :
Blocks C-fiber conduction, inactivates the release of
neuropeptides from peripheral nerve endings and
subsequently depletes the stores of substance P from sensory
neurons.
Dentistry Explorer
36. Topical Analgesic Medications
Generic name-Capsaicin
Brand name- ALGIPAN
Indications- Stomatodynia
Superficial neuropathic facial pain
Administration-Topical cream
Prescription/OTC-OTC/ Prescription
Dosage- 0.025%, 0.075% cream : apply t.i.d. / q.i.d. for at least 2 weeks
Contraindications-Allergy
Common side effects-
Unusual but important side effects- Neurotoxicity
Drug interactions- None
Monitoring-None
Dentistry Explorer
38. Systemic Non steroidal Anti-
inflammatory Drugs
Mechanism of action :
•Block cycloxygenase and prostaglandin synthesis ,
thereby reducing inflammation and pain due to
nociceptor sensitization .
Dentistry Explorer
39. Systemic Non steroidal Anti-
inflammatory Drugs
Generic name- Ibuprofen
Brand name- BRUFEN, EMFLAM
Indication- Mild to moderate nociceptive pain
Administration- Tablets, liquid
Prescription / OTC- Prescription and OTC
Dosage – Tablets: 200-400mg t.d.s. for 5-7 d
Liquid: 20-40mg/cc solution t.d.s. for 5-7 d
Dentistry Explorer
40. Systemic Non steroidal Anti-
inflammatory Drugs
Generic name-Naproxen
Brand name- NAPROXYN, NAXID
Indication – Mild to moderate nociceptive pain
Administration- Tablets, liquid
Prescription / OTC- Prescription and OTC
Dosage – Tablets: 250-500mg t.d.s.
Liquid: 125mg/5ml solution t.d.s.
Dentistry Explorer
47. Contraindication – Allergy, renal or liver impairment, combination with
anticoagulant or antiplatelet medications
Common side effects-Dyspepsia, nausea, abdominal pain, headache, dizziness,
Somnolence, rash, elevated liver enzymes, constipation,
fluid retention, peripheral edema, tinnitus, ecchymosis
Unusual but important side effects- GI bleeds and ulcers, myocardial
infarction, dermatitis, stroke, thromboembolism, hypertension, congestive
heart failure, nephrotoxicity, hepatotoxicity, bronchospasm, anaemia,
blood dyscrasias, Steven Johnson syndrome, toxic epidermal necrolysis
Interactions- Aspirin: increases risk of bleeding, reduces cardioprotective
effects
Mycophenolate mofetil: increases risk of bleeding and
nephrotoxicity
Gabapentin: somnolence
SSRIs: increases risk of bleeding
Tacrolimus: increases risk of nephrotoxicity
Monitoring-With chronic use: Complete Blood Count
Dentistry Explorer
48. Opiate analgesics
• Codeine sulphate
• Hydromorphone
• Meperidine
• Tramadol
• Oxycodone
• Morphine sulfate ER
• Oxycodone ER
• Fentanyl
Dentistry Explorer
49. Opiate
Mechanism of action :
• Acts by interaction with specific receptors present on neurones in the Central
Nervous System and peripheral tissues and mimicking the effect of the
endogenous pain-relieving chemicals dynorphin, enkephalin and β-enborphin.
•Receptors - µ, ĸ, δ
Dentistry Explorer
52. Opiate analgesics
Generic name-Tramadol
Brand name- CONTRAMAL, DOMADOL
Indication : moderate to severe nociceptive pain
Administration- CAPSULE
Prescription / OTC- Prescription
Dosage – Tablets: 50-100mg q.i.d. s.o.s.
Dentistry Explorer
53. Opiate analgesics
Generic name-Morphine sulfate ER
Brand name- MORPHINE SULFATE, MORCONTIN
Indication –Continuous/chronic moderate to severe pain;
extended release form
Administration- Tablets
Prescription / OTC- Prescription
Dosage – Tablets 15-30mg t.d.s. / b.d.
Dentistry Explorer
54. Contraindication – Allergy; watch combination with other opiates and
sedatives; impaired renal or liver function; history
of seizure disorder
Common side effects- Hypotension, sedation and mental clouding,
dizzy, constipatiuon, nausea, urinary retention, itching, asthma,
respiratory depression, palpitations, xerostomia; dependency with
prolonged use, abuse potential
Unusual but important side effects- Respiratory or CNS depression,
shock, cardiac arrest, paralytic
ileus, bradycardia.
Drug Interactions- Alcohol: increases sedation
Anticholinergics: increase constipation
CNS depressants: increase sedation
Monitoring- Therapeutic drug levels in chronic use, addiction
behaviour, functional and cognitive assessment
Dentistry Explorer
55. Combination NSAID-Opiate Analgesics
Generic name- Acetaminophen + codeine
Brand name- Tylenol #3
Indication - Moderate to severe nociceptive pain
Administration- Tablets and liquid
Prescription / OTC- Prescription
Dosage – Acetaminophen:300mg
Codeine: 30mg
2 tablets q.i.d. p.o. s.o.s.
Dentistry Explorer
62. Chlorhexidine Mouthwash
Bactericidal and Bacteriostatic
Mechanism of action :
• Chlorhexidine is a chemical antiseptic. It is
bacteriostatic at low concentration and bactericidal
at high concentration also useful against fungi .
Dentistry Explorer
63. Chlorhexidine for Treatment of Gingivitis
Generic name-Chlorhexidine 0.2 % rinse
Brand name-CHX, CHLORHEXIDINE
Indications-Gingivitis
Administration-Rinse
Prescription/OTC-Prescription
Dosage-10ml (1:1)rinse and expectorate bid for 10 days
Contraindications-Allergy
Common side effects-Dental staining, calculus build-up, taste
changes
Drug interactions- none
Monitoring-Clinical efficacy
Dentistry Explorer
65. Oral Antibiotics
B-lactam antibiotics
Mechanism of action :
• Acts by inhibiting the synthesis of bacterial cell
walls.
• It inhibits cross-linkage between the linear
peptidoglycan polymer chains that make up a
major component of the cell walls of both
Gram-positive and Gram-negative bacteria.
Dentistry Explorer
66. Oral Antibiotics
Generic name- Penicillin VK
Brand name- CRYSTAPEN-V, KAYPEN
Indications- Bacterial infection
Administration- Tablets
Prescription/OTC- prescription
Dosage- 500mg t.d.s. x 7-10d
Contraindications- Documented hypersensitivity
Common side effects-Rash, nausea, abdominal pain, diarrhoea
Unusual but important side effects-Acute allergic reaction and
anaphylaxis
Drug interactions-Chloroquine phosphate, methotrexate
Monitoring- Clinical efficacy
Dentistry Explorer
67. Oral Antibiotics
Generic name- Amoxicillin
Brand name- AMOXYLIN, NOVAMOX
Indications- Bacterial infection
Administration-Capsule
Prescription/OTC-Prescription
Dosage- 250-500mg t.d.s. x 7d
Contraindications- Documented hypersensitivity
Common side effects-Rash, nausea, abdominal pain, diarrhoea
Unusual but important side effects-Acute allergic reaction and anaphylaxis
Drug interactions- Probenacid, chloramphenicol, macrolides,
sulfonamides, tetracyclines
Monitoring- Clinical efficacy
Dentistry Explorer
68. Oral Antibiotics
Clindamycin
Mechanism of action :
• Clindamycin has a bacteriostatic effect. It is a bacterial
protein synthesis inhibitor by inhibiting ribosomal
translocation.
• It does so by binding to the 50S rRNA of the large bacterial
ribosome subunit.
Dentistry Explorer
69. Oral Antibiotics
Generic name- Clindamycin
Brand name- DALCAP, CLINCIN
Indications- Bacterial infection
Administration-Capsule
Prescription/OTC-Prescription
Dosage- 300mg q.i.d. x 7d
Contraindications- Documented hypersensitivity
Common side effects-Rash, nausea, abdominal pain, diarrhoea
Unusual but important side effects-Acute allergic reaction and
anaphylaxis
Drug interactions- Exenatide, contraceptives, mycophenolate,
neuromuscular blockers
Monitoring- Clinical efficacy Dentistry Explorer
70. Oral Antibiotics
Tetracycline
Mechanism of action :
• Tetracycline antibiotics are protein synthesis inhibitors, inhibiting the
binding of aminoacyl-tRNA to the mRNA-ribosome complex. They do
so mainly by binding to the 30S ribosomal subunit in the mRNA
translation complex.
Dentistry Explorer
71. Oral Antibiotics
Generic name-Tetracycline
Brand name- ACHROMYCIN, HOSTACYCLINE
Indications- Bacterial infection, Pemphigoid
Administration-Capsule
Prescription/OTC-Prescription
Dosage- 250-500mg q.i.d. x 7d
Contraindications- Documented hypersensitivity
Common side effects-Rash, nausea, abdominal pain, diarrhoea
Unusual but important side effects-Acute allergic reaction and
anaphylaxis
Drug interactions- Acitretin, retinoids, aminolevulinic acid,
hydroquinone, methoxsalen
Monitoring- Clinical efficacy
Dentistry Explorer
72. Oral Antibiotics
Azithromycin
Mechanism of action :
• Azithromycin prevents bacteria from growing by interfering with
their protein synthesis. Azithromycin binds to the 50S subunit of the
bacterial ribosome, and thus inhibits translation of mRNA. Nucleic
acid synthesis is not affected.
Dentistry Explorer
73. Oral Antibiotics
Generic name- Azithromycin
Brand name- AZITHRAL, AZIWOK
Indications- Bacterial infection
Administration-Capsule
Prescription/OTC-Prescription
Dosage- 500mg 1 day, then 250 mg for 2-5 d
Contraindications- Documented hypersensitivity
Common side effects-Rash, nausea, abdominal pain, diarrhoea
Unusual but important side effects-Acute allergic reaction and
anaphylaxis
Drug interactions- Warfarin, macrolides, fluconazole, efavirenz
Monitoring- Clinical efficacy
Dentistry Explorer
74. Intravenous Antibiotics
Vancomycin HCL
Imipenem/cilastatin
Mechanism of action :
• Imipenem acts as an antimicrobial through the inhibition of cell wall
synthesis of various gram-positive and gram-negative bacteria. This
inhibition of cell wall synthesis in gram-negative bateria is attained
by binding to pencillin binding proteins (PBPs).
Dentistry Explorer
75. Intravenous Antibiotics
Generic name-Vancomycin HCL
Brand name-VANCOGEN, VANCOLED
Indications-Bacterial infection
Administration- IV
Prescription/OTC-Prescription
Dosage-500mg IV b.d.
Contraindications- Documented hypersensitivity, impaired renal
function
Common side effects-Hypotension, fever, nausea, chills,
eosinophilia, rash
Drug interactions-Cidofovir, clofarabine, gallium nitrate
Monitoring- Efficacy, serum levels of vancomycin
Dentistry Explorer
76. Intravenous Antibiotics
Generic name- Imipenem/cilastatin
Brand name- CILASPENE, CIMISPECT
Indications- Bacterial infection
Administration- IM or IV
Prescription/OTC-Prescription
Dosage- 250-1000mg t.d.s.
Contraindications-Documented hypersensitivity
Common side effects-Thrombocytosis, diarrhea, rash,
phleblitis, elevated liver function
tests, elevated BUN and creatinine
Drug interactions-Ganciclovir
Monitoring- Efficacy, renal and hepatic function
Dentistry Explorer
77. Prophylactic Regimens of Antibiotics against Infective
Endocarditis for a Dental Procedure (1955 American Heart
Association)
Situation Agent Regimen-Single
dose 30-60 minutes
before procedure
Oral Amoxicillin Adults
2gm
Children
50mg/kg
Unable to take oral
medication
Ampicillin or
cefazolin or
ceftriaxone
2g IM or IV
1g IM or IV
50mg/kg IM or IV
50mg/kg IM or IV
Allergic to
penicillins or
ampicillin
Oral
Cephalexin or
clindamycin
Azithromycin or
clarithromycin
2g
600mg
500mg
50m/kg
20mg/kg
15mg/kg
Allergic to
penicillins or
ampicillin and
unable to take oral
medication
Cefazolin or
ceftriaxone
Clindamycin
phosphate
1g IM or IM
600mg IM or IV
50mg/kg IM or IV
20mg /kg IM or IV
Dentistry Explorer
81. Corticosteroids
Antiinflammatory and Immunosuppressant actions
Mechanism of action :
• Glucocorticoids cause their effects by binding
to the glucocorticoid receptor (GR).
•The activated GR complex in turn up-regulates
the expression of anti-inflammatory proteins in
the nucleus (a process known as
transactivation) and represses the expression
of pro-inflammatory proteins in the cytosol by
preventing the translocation of other
transcription factors from the cytosol into the
nucleus (transrepression).
Dentistry Explorer
82. Topical corticosteroids
Generic name-Beclomethasone
Brand name- BECLATE INHALER, BECORIDE
Indication- Severe recurrent aphthous stomatitis
- Behcet’s syndrome
- Pemphigus Vulgaris
- Pemphigoid
Administration- Metered inhaler spray topically to mucosal
lesions
Prescription / OTC- Prescription
Dosage- 50-100 micro g sprayed b.i.d. onto oral lesion until
symptom resolves
Dentistry Explorer
83. Beclomethasone contd…
Contraindication- Untreated infections
Common side effects- Oral candidiasis
Unusual but important side effects- Adrenal suppression
if doses exceeded
Drug Interactions- Unusual with topical preparations
Monitoring- Monitor if superinfection, especially
candidiasis
Dentistry Explorer
84. Topical corticosteroids
Generic name- Betamethasone
Brand name- BETNESOL, BETACORTRIL
Indications- Severe recurrent aphthous stomatitis
- Behcet’s syndrome
- Pemphigus Vulgaris
- Pemphigoid
Administration- Topical intraoral cream or gel
- soluble tablets as a mouthwash
Prescription / OTC- Prescription
Dosage- 0.1 % cream or 0.05 % gel applied thinly b.i.d.
- 0.5 mg 2-4 times daily as a mouthwash
Dentistry Explorer
85. Topical corticosteroids
Generic name- Clobetasol
Brand name- EUMOSON
Indication- Severe recurrent aphthous stomatitis
- Behcet’s syndrome
- Pemphigus Vulgaris
- Pemphigoid
Administration- Topical intraoral cream or gel
Prescription / OTC- Prescription
Dosage- 0.05 % cream or gel apply thinly b.i.d.
Dentistry Explorer
87. Betamethasone ,Clobetasol , Flucinonide
contd…
Contraindication- Untreated infections
Common side effects- Oral candidiasis
Unusual but important side effects- Adrenal suppression
if doses exceeded
Drug Interactions- Unusual with topical preparations
Monitoring- Monitor if superinfection, especially
candidiasis
Dentistry Explorer
90. Triamcinolone , Dexamethasone contd…
Contraindication- Hypersensitivity to corticosteriods,
- Systemic fungal infection
- Live vaccines
- Active tuberculosis
Common side effects- Candidiasis, hyperglycemia
Unusual but important side effects- Peptic ulceration
- Osteoporosis
- Impaired wound healing
- Mucosal atrophy
Drug Interactions- Increased insulin requirement
Monitoring- Blood pressure
- Bone density before and during prolonged
treatment
Dentistry Explorer
92. Prednisolone contd…
Dosage - 30-40 mg daily after breakfast for 4-5 days
- 1-2 mg/kg/d after breakfast until disease controlled
- 1-2 mg/kg/d, then maintenance of 2.5 – 15 mg daily
- 20-40 mg daily for 7-10 d at onset of lesions or until
lesions resolve
- 60 mg daily for 2 d, 50 mg daily for 2 d, 40 mg daily
for 2 d, 30 mg daily for 2 d, 10 mg daily for 2 d
Contraindication - Hypersensitivity to corticosteroids
- Systemic infection ( unless specific
antimicrobial therapy given )
- Peptic disease ( unless proton pump
inhibitor given )
- Live vaccines
Dentistry Explorer
93. Prednisolone contd…
Common side effects- Dyspepsia
- Candidiasis
- Myopathy
- Osteoporosis
- Adrenal suppression
- Cushing’s syndrome
- Euphoria
- Depression
Unusual but important side effects- Peptic ulceration with
perforation
- Cushingoid side effects
increasingly likely with doses
above 7.5 mg daily
Dentistry Explorer
94. Prednisolone contd…
Drug Interactions- Avoid live vaccines
- Increased risk of GI ulceration and bleeding
with aspirin and NSAIDS
- Increased insulin and oral hypoglycemic
requirements in diabetes mellitus
- Decreased response to warfarin, potentiated
by ketoconazole
Monitoring- Blood presure
- Bone density before and during prolonged treatment
- HPA axis suppression
Dentistry Explorer
95. Azathioprine
Immunosuppressant
Mechanism of action :
• Azathioprine is a DNA synthesis inhibitor, as it is converted to a purine
analogue inhibiting the proliferation of cells, especially lymphocytes. It is
an effective drug used alone in certain autoimmune diseases, or in
combination with other immunosuppressants in organ transplantation.
Dentistry Explorer
97. Azathioprine contd…
Contraindication – Hypersensitivity to Azathioprine, Pregnancy or
hope to become pregnant, Breast feeding, very low or absent
TPMT levels, Concurrent Allopurinol treatment, Concurrent
malignant disease, Renal or Hepatic insufficiency, Live vaccines
Common side effects- Hypersensitivity reactions, Nausea, vomiting,
Liver impairment, Susceptibility to infections
Unusual but important side effects- Pancreatitis
Drug Interactions- Allopurinol
Monitoring - TPMT activity before commencing treatment
- Blood tests for signs of myelosuppression
- Liver function
Dentistry Explorer
98. Cyclophosphamide
Immunosuppressant
Mechanism of action :
• The main effect of cyclophosphamide is due to its metabolite
phosphoramide mustard. This metabolite is only formed in cells that
have low levels of ALDH.
• Phosphoramide mustard forms DNA crosslinks between (interstrand
crosslinkages) and within (intrastrand crosslinkages) DNA strands at
guanine N-7 positions. This is irreversible and leads to cell death.
Dentistry Explorer
99. Cyclophosphamide
Generic name-Cyclophosphamide
Brand name- ENDOXAN, CYCLOXAN
Indication - Pemphigus vulgaris
- Pemphigoid
- Erythema multiforme
Administration- Tablets
Prescription / OTC- Prescription
Dosage –1-1.5 mg/kg/d
Contraindication – Porphyria, Pregnancy, Breast-feeding
Common side effects- Thinning hair, Darkened skin, Blistering skin,
Loss of appetite/weight
Unusual but important side effects- Hemorrhagic cyctitis
Drug Interactions- Increased absorption of Phenytoin, Clozapine,
Cytotoxics, Suxamethonium
Monitoring- Blood count, Liver function
Dentistry Explorer
100. Colchicine
Suppresses inflammation
Mechanism of action :
(1) a reduction in lactic acid production by leukocytes, which results in a
decrease in uric acid deposition, and
(2) a reduction in phagocytosis, with abatement of the inflammatory
response.
Dentistry Explorer
101. Colchicine
Generic name- Colchicine
Brand name- COLCHINDON
Indication - Severe recurrent aphthous stomatitis
- Behcet’s syndrome
Administration- Tablets
Prescription / OTC- Prescription
Dosage- 500 micro gm t.i.d.
Contraindication- Pregnancy
Common side effects- Nausea , Vomiting, Abdominal pain
Unusual but important side effects- Anorexia
Drug Interactions- Clarithromycin, Erythromycin, Cyclosporine
Monitoring- Blood test for Agranulocytosis , aplastic anemia
Dentistry Explorer
104. Thalidomide
Generic name-Thalidomide
Brand name- THALODA, TALIMYDE
Indication - Severe recurrent aphthous stomatitis
- Major aphthous stomatitis unresponsive to other
therapy
- Behcet’s syndrome
- Erythema multiforme
Administration- Tablets
Prescription / OTC- Prescribed only by those registered in the STEPS
program
Dosage – 100-300 mg daily with water at bedtime
Dentistry Explorer
105. Thalidomide contd…
Contraindication – Pregnancy, Unprotected intercourse if risk of
pregnancy
Common side effects- Severe birth defects, Peripheral neuropathy,
Drowsiness, Malaise, Dizziness, Headache,
Rash
Unusual but important side effects-Thrombotic events, Neutropenia,
Increased HIV viral load
Drug Interactions- Barbiturates, Alcohol, Chlorpromazine,
Reserpine
Monitoring- Baseline nerve conduction studies and after every 10
gm of drug
- Monthly pregnancy testing in women
- Follow STEPS program
Dentistry Explorer
106. Dapsone
Mechanism of action :
• It is structural analogue to PABA (Para amino
benzoic acid) and PABA is used by bacteria to
synthesise Folic acid.
• Inhibit bacterial folate synthesis which inturn
inhibit various essential metabolic reaction of
the mirobes.
Dentistry Explorer
107. Dapsone
Generic name- Dapsone
Brand name- DAPSONE
Indication - Pemphigus vulgaris
- Pemphigoid
- Erythema multiforme
-Behchet disease
Administration- Tablets
Prescription / OTC- Prescription
Dosage – 1-2 mg/kg/d
Contraindication – Porphyria, Anemia, Glucose-6-Phosphate dehydrogenase
Deficiency (requires reduced dose),Pregnancy,Breast-feeding
Common side effects- Hemolysis, Methemaglobinemia,Agranulocytosis,Skin
reactions
Unusual but important side effects- Dapsone syndrome (rash,fever,eosinophilia)
Drug Interactions- Plasma levels increase with Trimethoprim
Monitoring-Measure G6PD levels before treatment
Dentistry Explorer
116. Antifungal
Mechanism of action :
• Inhibits the fungal cytochrome P450 enzyme 14α-
demethylase. This inhibition prevents the
conversion of lanosterol to ergosterol, an essential
component of the fungal cytoplasmic membrane,
and subsequent accumulation of 14α-methyl
sterols.
Dentistry Explorer
117. Topical antifungal drugs
Generic name: Nystatin
Brand name: NYSTIN, MYCOSTATIN
Indications: Oropharyngeal candidiasis
Administration: Oral suspension, powder, cream, lozenge
Prescription/ OTC: prescription
Dosage: Oral suspension (100,000U/ml): 400,000-600,000 units 4-5 times/d(swish
and swallow)
Troche (200,000U): 200,000-400,000 U 4-5 times/d
100,000U/g cream and oinment: Apply to affected area 4-5 times/d
Powder (50 million U): Sprinkle on tissue contact area of denture
Contraindications: Hypersensitivity to nystatin
Common side effects: Nausea, vomiting, diarrhoea, stomach pain, contact dermatitis
Unusual but important side effects: Hypersensitivity
Drug interactions: None
Monitoring: Liver function test
Dentistry Explorer
118. Topical antifungal drugs
Generic name: Clotrimazole
Brand name: SURFAZ, CLOTRIN
Indications: Oropharengeal candidiasis
Administration: Troche
Prescription/ OTC: Prescription and OTC
Dosage: 10mg troche: dissolve slowly over 15-30min
5 times daily: apply to affected area b.i.d. for 7d
cream can be applied to the tissue contact areas of the denture
Contraindications: Hypersensitivity to clotrimazole
Common side effects: Abnormal liver function test, nausea, vomiting,
local mild burning, irritation, stinging
Unusual but important side effects: Avoid contact with eyes
Drug interactions: None
Monitoring: Liver function test Dentistry Explorer
119. Systemic antifungal drugs
Generic name: Fluconazole
Brand name: SYSCAN, ZOCON
Indications: Oral and esophageal candidiasis
Administration: Capsule, powder
Prescription/ OTC: Prescription
Dosage: Tablets: 200mg on day 1 then 100mg daily for 7-14d
Powder for oral suspension (10mg/ml); dosing is the same as
for tablet
Contraindications: Hypersensitivity to azole drugs, left ventricular
dysfunction, congestive heart failure
Common side effects: Headache, nausea, vomiting, abdominal pain,
rash, diarrhoea, taste perversion, dyspepsia
Unusual but important side effects: Anaphylactic reactions, liver failure
Drug interactions: Cisapride
Monitoring: Liver and renal function test, potassium
Dentistry Explorer
120. Systemic antifungal drugs
Generic name: Itraconazole
Brand name: SPORONAX, CANDITRAL
Indications: Oral and esophageal candidiasis
Administration: Solution
Prescription/ OTC: Prescription
Dosage: Solution (10mg/ml); 100-200mg/10ml once a day for 1-2 wk; if
refractory to fluconazole: 100mg b.d.
Contraindications: Hypersensitivity to azole drugs, left ventricular dysfunction,
congestive heart failure
Common side effects: Nausea, edema, hypertension, headache, fatigue,
malaise, fever, dizziness, rash, pruritis, decreased libido, hyperkalemia,
abdominal pain, anorexia, vomiting, diarrhoea, increased liver enzymes,
hepatitis
Unusual but important side effects: Adrenal suppression, allergic reactions,
arrhythmia, congestive heart failure, Stevens- Johnson syndrome
Drug interactions: Inhibits certain cytochrome P-450 substrates
Monitoring: Liver function tests after 1 month of treatment
Dentistry Explorer
121. Systemic antifungal drugs
Generic name: Ketoconazole
Brand name: NRAL, KETOVATE
Indications: Oral and esophageal candidiasis
Administration: Cream ,Tablets
Prescription/ OTC: Prescription
Dosage: Rub gently into the affected area 1-2 times daily
200-400mg/d as single dose for 7-14d
Contraindications: Hypersensitivity to ketoconazole; administration with ergot
derivatives or cisapride
Common side effects: Pruritis, nausea, vomiting, abdominal pain
Unusual but important side effects: Bulging fontanelles, chills, depression,
diarrhoea, dizziness, fever, gynecomastia, headaches, hemolytic anemia,
hepatotoxicity, impotence, leukopenia, photophobia, somnolence,
thrombocytopenia
Drug interactions: Inhibits certain cytochrome P-450 substrates
Monitoring: Liver function tests
Dentistry Explorer
123. Sialogogues
Cholinergic agonist
Mechanism of action :
• Pilocarpine is a cholinergic parasympathomimetic agent. It increase
secretion by the exocrine glands, and produces contraction of the iris
sphincter muscle and ciliary muscle (when given topically to the eyes) by
mainly stimulating muscarinic receptors.
Dentistry Explorer
124. Pilocarpine hydrochloride
Generic name- Pilocarpine hydrochloride
Brand name-CARPIN
Indication - 1.Symptoms of dry mouth from salivary gland
hypofunction caused by radiotherapy for cancer of
head and neck.
2. Symptoms of dry mouth in patients with Sjögren’s
syndrome
Administration- Tablets
Prescription / OTC- Prescription
Dosage – 5 mg t.i.d. adjusted to theraputic response and tolerability. Usual
dose range is 15-30 mg daily, not to exceed 10mg/dose. 12
weeks of uninterrupted therapy is recommended.
Dentistry Explorer
125. Cevimeline hydrochloride
Generic name- Cevimeline hydrochloride
Brand name- ALBAQUIN
Indication - 1. Symptoms of dry mouth from salivary gland
hypofunction caused by radiotherapy for cancer of
head and neck.
2. Symptoms of dry mouth in patients with Sjögren’s
syndrome
Administration- Tablets
Prescription / OTC- Prescription
Dosage – 30mg t.i.d.
Dentistry Explorer
126. Contraindication – Uncontrolled asthma, hypersensitivity to drug, acute iritis,
narrow-angle (angle closure) glaucoma, acute hepatic
impairment.
Common side effects- Sweating, nausea, rhinitis, diarrhoea, chills, flushing,
urinary frequency, dizziness, asthenia, headache,
dyspepsia, lacrimation
Unusual but important side effects- Visual disturbances, atrioventricular block,
biliary contractions and obstruction,
precipitation of renal colic
Drug Interactions- Beta- adrenergic antagonists: use with caution
All drugs with parasympathomimetc effects
Drugs intended to cause anticholinergic effects
Monitoring- Monitor for significant side effects.
Pilocarpine hydrochloride ,
Cevimeline hydrochloride contd…
Dentistry Explorer
127. Amifostine
Mechanism of action :
•Accelerated DNA repair,induction of cellular hypoxia,inhibition of
apoptosis,alteration of gene expression and modification of enzyme
activity.
Dentistry Explorer
128. Amifostine
Generic name- Amifostine
Brand name-AMFOS, AMIPHOS
Indication -1. To reduce the incidence of moderate to severe
xerostomia in patients undergoing postoperative radiation
treatment for head and neck cancer, where the radiation port
includes a substantial portion of the parotid glands.
2. Can be used off-label to reduce the incidence of
moderate to severe xerostomia in patients
undergoing radiation treatment of head and neck
cancer in combination with chemotherapy
Administration- Tablets
Prescription / OTC- Prescription
Dentistry Explorer
129. Amifostine contd…
Dosage – 200mg/m2 administered once daily as a 3 min IV infusion,
starting15-30 min prior to radiation treatment.
- 500mg reconstituted with 2.5ml normal saline given
subcutaneously in one or two injections, once daily, 15min prior
to radiation treatment.
Contraindication – Sensitivity to aminothiol compounds, hypotension,
dehydration
Common side effects- Transient hypotension, nausea,vomiting, flushing,
chills, fever, dizziness,somnolence, hiccups,
sneezing
Unusual but important side effects- Acute allergic reaction and
anaphylaxis, hypocalcemia, short-
term reversible loss of consciousness
Dentistry Explorer
130. Amifostine contd…
Drug Interactions- amifostine should be used with caution in
patients taking antihypertensive drugs or
other drugs that could cause or potentiate
hypotension.
Monitoring- Adequate hydration prior to administration
-Blood pressure during and after administration
-Nausea and vomiting- antiemetic medication should
be given prior to and in conjunction with amifostine (oral
5HT3 receptor antagonists)
-Serum calcium levels in patients at risk of hypocalcaemia
(nephritic syndrome)
Dentistry Explorer
131. Glycopyrrolate
Synthetic Antisecretory-antispasmodic
Mechanism of action :
Glycopyrrolate binds competitively to the muscarinic acetylcholine receptor. it
inhibits the action of acetylcholine on structures innervated by postganglionic
cholinergic nerves and on smooth muscles that respond to acetylcholine but
lack cholinergic innervation. These peripheral cholinergic receptors are present
in the autonomic effector cells of smooth muscle, cardiac muscle, the sinoatrial
node, the atrioventricular node, exocrine glands and, to a limited degree, in the
autonomic ganglia. Thus, it diminishes the volume and free acidity of gastric
secretions and controls excessive pharyngeal, tracheal, and bronchial
secretions.
Dentistry Explorer
134. Atropine
Generic name- Atropine
Brand name- ATROPINE SULPHATE
Indication – Sialorrhea
Administration- Tablets
Prescription / OTC- Prescription
Dosage – 0.4mg 30-60 min before dental procedures
0.4mg q.i.d.as needed to inhibit drooling
Dentistry Explorer
135. Glycopyrrolate, Atropine contd…
Contraindication – Glaucoma, chronic constipation, ulcerative
colitis, acute hepatic impairment
Common side effects- dry skin, constipation, dry throat, xerostomia,
dry nose, dysphagia, drowiness
Unusual but important side effects- Fast/ irregular heart beat, heat
stroke in hot weather, difficulty
urinating
Drug Interactions- increased toxicity with antacids, effects of other
anticholinergic agents may be increased with
these drugs
Monitoring- monitor for significant side effects
Dentistry Explorer
137. Anticonvulsants
Mechanism of action :
• Voltage-gated sodium channels are the molecular pores that allow
brain cells (neurons) to generate action potentials, the electrical events
that allow neurons to communicate over long distances. After the
sodium channels open to start the action potential, they inactivate,
essentially closing the channel. Carbamazepine stabilizes the inactivated
state of sodium channels, meaning that fewer of these channels are
available to subsequently open, making brain cells less excitable (less
likely to fire). Carbamazepine has also been shown to potentiate GABA
receptors made up of alpha1, beta2, gamma2 subunits .
Dentistry Explorer
138. Anticonvulsants
Generic pain- Carbamazepine
Brand name- TEGRETOL, MAZETOL
Indications- Cranial neuralgias, traumatic neuropathy,
neuropathic pain of undetermined origin, less
commonly for stomatodynia (burning mouth)
Administration-Tablets
Suspension
Prescription/OTC- Prescription
Dosage- Tablets: 200-600mg b.i.d. Slow escalation
Suspension: 100mg/5 cc; dosed as needed 200-
600mg b.i.d.
Dentistry Explorer
139. Carbamazepine contd…
Contraindications- Allergy, hypersensitivity to TCAs, recent MAO
inhibitor use, marrow depression, impaired liver or renal function,
cardiac disease
Common side effects- Dizziness, drowsiness, nausea/vomiting, blurred
vision, allergic rash, cognitive impairment, elevated liver enzymes,
hyponatremia, ataxia
Unusual but important side effects- Withdrawal seizures, arrythmias,
syncope, anemia, pancytopenia, hepatits, hyponatremia, Stevens-
Johnsons syndrome(rare), erythema multiforme(rare)
Drug interactions- CNS depressants: additive sedation
Azole antifungals
Doxycycline
Monitoring- Drug levels, Complete Blood Count, metabolic panel, liver
function Dentistry Explorer
140. Anticonvulsants
Generic name- Gabapentin
Brand name- NEURONTIN
Indications- Cranial neuralgias, traumatic neuropathy, neuropathic pain
of undetermined origin, less commonly for stomatodynia (burning
mouth)
Administration-Capsule
Suspension
Prescription/OTC- Prescription
Dosage- Tablets: 300-1200mg t.i.d. Slow escalation
Solution: 250mg/5ml; dosed as needed 200-600mg b.i.d.
Dentistry Explorer
141. Gabapentin contd…
Contraindications- Allergy, congestive heart failure, impaired
renal function, careful use in elderly
Common side effects- Dizziness, somnolence, ataxia,
peripheral edema, weight gain,
blurred vision, cognitive impairment, dry mouth, tremor,
headache, constipation, neuropathy, decreased platelets
Unusual but important side effects- Severe skin reactions, CHF
exacerbation, severe myalgia, thrombocytopenia
Drug interactions- CNS depressants; additive sedation
Monitoring- Drug levels , Complete Blood Count
Dentistry Explorer
142. Anticonvulsants
Generic name- Lamotrigine
Brand name- LAMITOR, LAMIDUS
Indications- Cranial neuralgias, traumatic neuropathy,
neuropathic pain of undetermined origin, less commonly
for stomatodynia(burning mouth)
Administration- tablets
Prescription- Prescription/OTC
Dosage- 50-200mg b.i.d. slow escalation
Dentistry Explorer
143. Anticonvulsants
Generic name- Topirimate
Brand name- TOPEX
Indications- Cranial neuralgias, traumatic neuropathy,
neuropathic pain of undetermined origin, less commonly
for stomatodynia (burning mouth)
Administration- Tablets
Prescription/OTC- Prescription
Dosage-50-100mg b.i.d. slow escalation
Dentistry Explorer
144. Lamotrigine , Topirimate contd…
Contraindications- Allergy, impaired liver or renal function
Common side effects- Metabolic acidosis, dizziness, somnolence,
fatigue, nervousness, paresthesias, cognitive impairment, ataxia,
anorexia, nausea, depression, diarrhea, mood disturbances,
tremor, taste changes, weight loss, insomnia
Unusual but important side effects- Metabolic acidosis,
osteomalacia, osteoporosis, growth suppression(pediatrics),
diabetes mellitus, leukopenia, anemia, psychosis, skin reaction,
hepatotoxicity, fatal pancreatitis, deep vein thrombosis,
pulmonary embolism
Drug interactions- CNS depressants(additive sedation), oral
contraceptives, carbamazepine, azole antifungals
Monitoring-Drug level, Complete Blood Count, metabolic panel
Dentistry Explorer
145. Antidepressant and Anxiolytic
• Amitriptyline
• Nortriptyline
• Imipramine
• Clonazepam
• Doxepin
• Duloxetin
Dentistry Explorer
146. Antidepressant and Anxiolytic
Mechanism of action :
• Inhibits the membrane pump mechanism responsible for
uptake of norepinephrine and serotonin in adrenergic and
serotonergic neurons.
• Exerts its action by binding to the benzodiazepine site of the
GABA receptors, which causes an enhancement of the electric
effect of GABA binding on neurons, resulting in an increased
influx of chloride ions into the neurons. This results in an
inhibition of synaptic transmission across the central nervous
system
Dentistry Explorer
147. Antidepressant and Anxiolytic
Generic name- Amitriptyline
Brand name- AMLINE, SAROTENA
Indications-Adjuvant for cranial neuralgias, primary for generalized
neuropathic pain, stomatodynia(burning mouth)
Administration- Tablets
Prescription/OTC- Prescription
Dosage-10-100mg h.s.
Dentistry Explorer
148. Antidepressant and Anxiolytic
Generic name-Nortriptyline
Brand name- SENSIVAL, PRIMOX
Indications-Adjuvant for cranial neuralgias, primary for generalized
neuropathic pain, stomatodynia(burning mouth)
Administration- Tablets
Prescription/OTC- Prescription
Dosage- 10-75 mg h.s.
Dentistry Explorer
149. Antidepressant and Anxiolytic
Generic name- Imipramine
Brand name- DEPSONIL, ANTIDEP
Indications-Adjuvant for cranial neuralgias, primary for generalized
neuropathic pain,stomatodynia(burning mouth)
Administration-Tablets, Capsule
Prescription/OTC- prescription
Dosage- 10-50 mg h.s.
Dentistry Explorer
151. Unusual but important side effects- Orthostatic hypotension,
hypertension,syncope, arrythmia, AV block, myocardial
infarction, stroke, seizures, tardive dyskinesia(rare),
pancytopenia, hallucinations, suicidality, hepatitis(rare),
angioedema, hyperthermia
Drug interactions-CNS depressants: additive depression
Monitoring- Drug level, Complete Blood Count, metabolic
panel, Electrocardiography
Dentistry Explorer
152. Antidepressant and Anxiolytic Medications
Generic name- Clonazepam
Brand name-LONZEP, CLONAPAX
Indications-Adjuvant for cranial neuralgias, primary medication for
generalized neuropathic pain,
stomatodynia(burning mouth)
Administration-Tablets
Transmucosal water
Prescription/OTC-Prescription
Dosage-Tablets: 0.5-4mg h.s. or divided during day
Water:0.25 mg q.i.d. s.o.s.
Dentistry Explorer
153. Clonazepam contd…
Contraindications-Allergy, impaired liver function,impaired
respiratory function
Common side effects-Withdrawal syndrome, drowsiness, ataxia,
cognitive impairment,constipation, diarrhea,
dry mouth, headache, sleep changes,
hypotension, rash
Unusual but important side effects- Respiratory depression,
neutropenia, hepatotoxicity,
seizures
Drug interactions-CNS depressant: additive depression; azole
antifungals; carbamazepine; erythromycin; opiates;
pregablin
Monitoring-Complete Blood Count, metabolic panel
Dentistry Explorer
157. Muscle Relaxant
Mechanism of action :
• produces its effects by modulating the GABA
receptor.
Dentistry Explorer
158. Muscle Relaxants
Generic name-Baclofen
Brand name-LIORESAL
Indications-Myofascial pain with muscle tension component
Administration-Tablets
Prescription/OTC-Prescription
Dosage-10-20mg b.i.d. for 3 months
Contraindications-Allergy, impaired renal function, seizure, stroke,
diabetes, elderly patients
Common side effects-Drowsiness, dizziness, dry mouth, fatigue,
hypotension, nausea, vomiting, nervousness,
confusion, headache, rash, pruritis
Unusual but important side effects-CNS and respiratory depression, ataxia,
seizures,hallucinations
Drug interactions-CNS depressants: additive depression
Monitoring-None
Dentistry Explorer
159. Muscle Relaxants
Generic name-Carisoprodol
Brand name-CARISOMA, SOMAFLAM
Indications-Myofascial pain with muscle tension component
Administration-Tablets
Prescription/OTC-Prescription
Dosage-350mg t.i.d./q.i.d.
Contraindications-Allergy, impaired renal and liver function
Common side effects- Drowsiness, dizziness, dry mouth, fatigue,
hypotension, nausea, vomiting, nervousness,
confusion, headache, rash, pruritis
Unusual but important side effects-Erythema multiforme,anaphylaxis
Drug interactions-CNS depressants: additive depression
Monitoring-None
Dentistry Explorer
160. Muscle Relaxants
Generic name-Tizanidine
Brand name-SIRDALUD, TIZAN
Indications-Myofascial pain with muscle tension component
Administration-Tablets
Prescription/OTC-Prescription
Dosage-8mg t.d.s. / q.i.d. s.o.s.
Contraindications-Allergy, impaired renal and liver function
Common side effects- Drowsiness, dizziness, dry mouth, fatigue,
hypotension, nausea, vomiting, nervousness,
confusion, headache, rash, pruritis
Unusual but important side effects-Hepatotoxicity, bradycardia,
hypotension, hypertension
Drug interactions-CNS depressants: additive depression, oral
contraceptives
Monitoring-Liver function
Dentistry Explorer
161. Conclusion
As in Oral Medicine we deal with the oral mucosal
diseases, salivary gland disorders, facial pain
syndromes and also provide dental care for patients
with complicating medical disease, therefore it is
essential to keep in mind the various drugs in terms of
Mechanism of action , Generic name, Brand name ,
Indication , Administration , Prescription / OTC ,
Dosage , Duration , Contraindication , Common side
effects , Unusual but important side effects , Drug
interactions, Monitoring while writing a prescription
for the diseases mentioned above.
Dentistry Explorer
162. References :
Burket’s Oral medicine -11th Edition
Martin S. Greenberg
Michael Glick
Jonathan A. Ship
Essentials of Medical Pharmacology -5th Edition
KD Tripathi
Oxford Handbook of Clinical Dentistry-5th Edition
Laura Mitchell
David A. Mitchell
with Lorna McCaul
Principles of Dental Pharmacology
Naresh Kumar Khanna
Dentistry Explorer
163. MCQs
• Which one is correct way of prescribing a
drug…
A. Rx caps Amoxicillin 500 mg t.i.d. p.o. 1 week
B. Rx caps Amoxicillin 500 mg po t.i.d. 1 week
C. Rx Amoxicillin 500 mg caps t.i.d. p.o. 1 week
D. Rx Amoxicillin 500 mg caps p.o t.i.d. 1 week
Dentistry Explorer
167. MCQs
• Amoxicillin for Intraoral Bacterial
Manifestation for an adult is prescribed as…
A. 250 mg t.d.s.
B. 500 mg t.d.s.
C. 250 mg b.d.
D. 500 mg b.d.
Dentistry Explorer
169. MCQs
• Drug used for reduction of Xerostomia in
Patients Undergoing Head and Neck
Radiotherapy for Cancer is…
A. Pilocarpine hydrochloride
B. Cevimeline hydrochloride
C. Atropine
D. Amifostine
Dentistry Explorer
