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Dental Anesthetics and Porphyrics



     All porphyria patients must read this dental informational and then check all information against the latest porphyria UNSAFE DRUG lists, as well as against their own unsafe drugs which have proven harmful to them for such reasons as allergic reaction, or contraindicated with other medications they may be taking.

     Please be advised that many of the dental anesthetics contain sulfites and for many porphyria patients the sulfites have been traditionally unsafe due to allergic reactions. Many porphyria patients tend to be more sensitive than others to various substances, sulfites being one of them.

     There are all kinds of anesthetics used by dentists for numbing your gums. This is all necessary to allow the dentist to work on your teeth.

     Some are very safe, but a lot of the newer ones are considered unsafe.

     Why unsafe you ask?

     Many of the newer drugs are combinations of the older ones put together with others that are newer or are contraindicated for porphyrics. Old-fashioned Novacaine is one thing, but having that "caine" suffix included in newer dental anesthetics does not make it safe.

     Another thing it is most important to remember, many of the dental drugs have trace amounts of cocaine contained within their compound makeup.

     The following are today's leading dental anesthetics. Every porphyric reacts to pharmaceuticals differently.

ARTICAINE

     Articaine is the generic name of one of the newer dental anesthetics. It contains hydrochloride and epinephrine.

     A brand name for Articaine is Septocine TM.

     Articaine / Septocine carries a warning about use in patients with liver disease, and if used with such patients, dosages should be reduced.

     Adverse effects of Articaine / Septocaine TM include pain, headache, face edema, infection, gastrointestinal system - gingivitis , and paresthesia in the nervous system.

In controlled trials, occurring <1%, and considered clinically significant, Abdominal pain, accidental injury, arthralgia, asthenia, back pain, constipation , diarrhea, dizziness, dry mouth, dysmenorrhea, dyspepsia, ear pain, ecchymosis, edema, facial paralysis, glossitis, gum hemorrhage, hemorrhage, hyperesthesia, increased salivation, injection site pain, lymphadenopathy, malaise, migraine, mouth ulceration, myalgia, nausea, neck pain, nervousness, neuropathy, osteomyelitis, paresthesia, pharyngitis, pruritus, rhinitis, skin disorder, somnolence, stomatitis, syncope, tachycardia, taste perversion, thirst, tongue edema, tooth disorder, vomiting

     Contraindications in Articaine / SeptocaineTM is contraindicated in patients with hypersensitivity to local anesthetics of the amide type or to sodium metabisulfite.      Warnings/Precautions: Because SeptocaineTM contains epinephrine, which can cause local tissue necrosis or systemic toxicity, usual precautions for epinephrine administration should be observed. It also contains sodium metabisulfite, which may cause allergic-type reactions (including anaphylactic symptoms, and life-threatening or less severe asthmatic episodes) in certain susceptible patients. This is known as sulfite sensitivity.

RAVOCAINE

     One of the newer dental anesthetics is called RAVOCAINE. This anesthetic also contains Novocain, Levophed, Propoxycaine, Procaine and Norepinephrine Bitartrate. The manugacturer of this drug is Cook-Waite, a division of Kodak.

     This drug is a local anesthetic combination in the para-aminobenzoic acid ester group. It has a duration of action is from 2-3 hours.

     Precautions: The lowest dose that results in effective anesthesia should be used to avoid high plasma levels and serious undesirable systemic side effects, hypertension, arteriosclerotic heart disease, cerebral vascular insufficiency, heart block, thyrotoxicosis, and diabetes.

Warning: This drug contains a SULFITE that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people.

     Drug Interactions: MAO inhibitors, tricyclic antidepressants, phenothiazines.

     Adverse Reactions: CNS reactions are characterized by excitation and/or depression. Nervousness, dizziness, blurred vision, or tremors may occur followed by drowsiness, convulsions, unconsciousness, and possibly respiratory arrest. Depression of the myocardium, hypotension, profound bradycardia, and cardiac arrest. Allergic reactions, characterized by cutaneous lesions of delayed onset, or urticaria, edema, and other manifestations of allergy.

MARCAINE

     Marcaine is another well known dental anesthetic. It is used in combintation with Epinephrine or Bupivacaine. This drug is manufactured by Cook-Waite Drugs which again is a division of Kodak.

     Marcaine is a homologue of mepivacaine and is chemically related to lidocaine.

     It belongs to the piperdine group. This anesthesia may last 2 or 3 times longer than lidocaine and mepivacaine. It can be prolonged by the use of epinephrine.

     Precautions: Existence of hypertension, arteriosclerotic heart disease, cerebral vascular insufficiency, heart block, thyrotoxicosis and diabetes, patients receiving drugs likely to produce alterations in blood pressure.

Contains a SULFITE that may cause allergic-type reactions

Warning: Changes in sensorium such as excitation, disorientation, drowsiness may be early indications of a high blood level of the drug and may occur following inadvertent intravascular administration or rapid absorption. Use cautiously in areas with limited blood supply. Peripheral vascular disease, LIVER disease.

**Please note that hepatic porphyrias are considered a liver disease.

     Use with caution when there is inflammation and/or sepsis in the region of the proposed injection.

     Drug Interactions: Monoamine oxidase inhibitors, tricyclic antidepressants, vasopressor drugs, ergot-type oxytocic drugs, phenothiazines, butyrophenones.

     Adverse Reactions: Blood pressure changes (usually hypotension), cardiac arrest, allergic reactions, hypersensitivity, transient facial swelling and puffiness, CNS reactions are characterized by excitation or depression. Nervousness, dizziness, blurred vision, or tremors, followed by drowsiness, convulsions, unconsciousness, and possibly respiratory arrest. Nausea, vomiting, chills, constriction of the pupils, tinnitus, depression of the myocardium, edema.

LIDOCAINE

     Lidocaine is a familiar dental anesthetic. It is also manufacturered by Cook-Waite, a division of Kodak. It provides up to 90 minutes of numbing effects. It is a member of the amide type drugs.

     Precautions: Contains sodium metabisulfite, a SULFITE that may cause allergic-type reactions.

     Should be used very cautiously in areas of the body supplied by end arteries or having otherwise compromised blood supply, or patients with peripheral vascular disease, hypertensive vascular disease, HEPATIC disease, or impaired cardiovascular function. [Remember porphyria is classified as a hepatic disease ].

     Drug Interactions: Monoamine oxidase inhibitors, tricyclic antidepressants or phenothiazines, vasopressor drugs, ergot-type oxytocic drugs.

     Adverse Reactions: CNS manifestations are excitatory and/or depressant characterized by lightheadedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double vision, vomiting, sensations of heat, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression and arrest. Drowsiness is usually an early sign of high blood level. Bradycardia, hypotension, and cardiovascular collapse which may lead to cardiac arrest. Allergic reactions are characterized by cutaneous lesions, urticaria, edema or anaphylactoid reactions.

     Another name for LIDOCAINE is XYLOCAINE.



CARBOCAINE / MEPIVACAINE

     CARBOCAINE with NEOCOBEFRIN or MEPIVACAINE and LEVONORDEFRIN, are both manufactured by Cook-Waite, a division of Kodak,      Contraindications: Hypersensitivity to amide-type local anesthetics.

     Precautions: Contains a vasoconstrictor that should be used with extreme caution, existence of hypertension, arteriosclerotic heart disease, cerebral vascular insufficiency, thyrotoxicosis and diabetes.

     Contains a SULFITE that may cause allergic-type reactions.

     Adverse Reactions: CNS reactions are characterized by excitation and/or depression. Nervousness, dizziness, blurred vision, or tremors may occur followed by drowsiness, convulsions, unconsciousness, and possibly respiratory arrest, cardiovascular reactions are depressant.

     Anaphylactoid reactions to CARBOCAINE have occurred rarely.

ETIDOCAINE / DURANEST

     ETIDOCAINE HCl is manufactured by Astra. A brand name for this drug is DURANEST. It has a prolonged duration of action of 5 to 10 hours.

     Contraindications: Hypersensitivity to local anesthetics of the amide type.

     Precautions: . Contains sodium metabisufite, a SULFITE that may cause allergic-type reactions.

Warning: Use with caution in patients with severe shock or heart block, existing neurological disease, spinal deformities, septicemia, severe hypertension, peripheral vascular disease. Areas of the body supplied by end arteries or having otherwise compromised blood supply. HEPATIC disease, impaired cardiovascular function. May be a potential triggering agent for familial malignant hyperthemia.

     Drug Interactions: Monoamine oxidase inhibitors, tricyclic antidepressants or phenothiazines.

     Allergic reactions are usually characterized by CUTANEOUS LESIONS, uticaria, edema or anaphylactoid reactions. Drowsiness following the administration of etidocaine is usually an early sign of high blood level of the drug and may occur as a consequence of rapid absorption.

DYCLONINE / DYCLONE

     DYCLONINE is another name for DYCLONE, a dental anesthesia manufactured by Astra. It is a short acting drug and last for about 30 minutes.

     Contraindications: Hypersensitivity to the local anesthetic or to other components of Dyclone solutions.

     Precautions: There is the potential for rapid systemic absorption

     Adverse Reactions: CNS manifestations are excitatory and/or depressant and may be characterized by lightheadedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double vision, vomiting, sensations of heat, cold, or numbness.

     Drowsiness following the administration of Dyclone is usually an early sign of a high blood level of the drug and may occur as a consequence of rapid absorption. Cardiovascular manifestations are usually depressant and are characterized by bradycardia, hypotension.

CITANEST FORTE / PROLOCAINE

     CITANEST FORTE is a combination of PROLOCAINE and EPINEPHRINE. This anesthesia is also manifactured by Astra.

     There is also CITANEST PLAIN which can last up to 60 minutes.

     Precautions: Citanest Forte contains a SULFITE that may cause allergic-type reactions including anaphylactic symptoms.

     Restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression or drowsiness should alert the practitioner to the possibility of central nervous system toxicity.

Warning: Hepatic disease.

     Drug Interactions: MAO inhibitors, tricyclic antidepressants, phenothiazines, vasopressor drugs, ergot-type oxytocic drugs.

     Adverse Reactions:Allergic reactions are characterized by CUTANEOUS LESIONS, urticaria, edema or anaphylactoid reactions. CNS manifestations are excitatory and/or depressant and may be characterized by lightheadedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double vision, vomiting, sensations of heat, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression and arrest. Swelling and persistent parasthesia of the lips and oral tissue may occur.

CITANEST FORTE

     CITANEST FORTE a.k.a.PROLOCAINE with EPINEPHRIE is also made by Astra Manufacturimg

     Precautions: Citanest Forte contains a SULFITE that may cause allergic-type reactions including anaphylactic symptoms.

Patients with severe shock or heart block, vasoconstrictor should be used with caution in areas of the body supplied by end arteries or having otherwise compromised blood supply, peripheral vascular disease, hypertensive vascular disease, potent general anesthetic agents.

     Restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression or drowsiness should alert the practitioner to the possibility of central nervous system toxicity.

Warning: Hepatic disease

     Drug Interactions: MAO inhibitors, tricyclic antidepressants, phenothiazines, vasopressor drugs, ergot-type oxytocic drugs.

     Adverse Reactions: Allergic reactions are characterized by cutaneous lesions, urticaria, edema or anaphylactoid reactions.

     CNS manifestations are excitatory and/or depressant and may be characterized by lightheadedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double vision, vomiting, sensations of heat, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression and arrest. Swelling and persistent parasthesia of the lips and oral tissue may occur.

Sandra MacDonald CDA
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