title: 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.affiliation: Department of Oral Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine, Philadelphia, PA 19104-6030, USA. evhersh@pobox.upenn.edu
authors.forename: Elliot V
authors.initials: EV
authors.lastname: Hersh
authors.forename: Helen
authors.initials: H
authors.lastname: Giannakopoulos
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects* / Q000494:pharmacology; D000766:Anesthesia, Dental / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D001919:Bradycardia / Q000139:chemically induced*; D004347:Drug Interactions; D004837:Epinephrine / Q000009:adverse effects; D006801:Humans; D006973:Hypertension / Q000139:chemically induced*; D008790:Metoprolol / Q000009:adverse effects; D008771:Nordefrin / Q000009:adverse effects; D011433:Propranolol / Q000009:adverse effects; D014662:Vasoconstrictor Agents / Q000009:adverse effects*
chemical_list: D000319:Adrenergic beta-Antagonists; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D011433:Propranolol; D008790:Metoprolol; D008771:Nordefrin; D004837:Epinephrine