Ciprofloxacin
Common brand names: Cipro, Floxin
Related drug: Ofloxacin
Description: Ciprofloxacin and ofloxacin are members of the quinolone class of antibiotics and are used in medicine to treat infections of the urinary, intestinal and lower respiratory tracts, plus infections of the skin, bones and joints.
Dental uses: Ciprofloxacin is not commonly employed to treat dental infections, although its use among dentists is rising, especially among periodontists for various periodontal infections. Rare dental infections caused by the Pseudomonas species of bacteria are effectively treated by ciprofloxacin and ofloxacin.
Dosages for dental purposes: The typical adult dose of ciprofloxacin is 500 milligrams to 750 milligrams every 12 hours for seven to 10 days. Ciprofloxacin and ofloxacin (like tetracyclines) should not be ingested with dairy products (milk, yogurt), antacids (Tums, Rolaids, Maalox, Mylanta, Pepto-Bismol), or iron and zinc supplements, because these products greatly inhibit the absorption of the drugs from the gastrointestinal tract into the bloodstream.
Concerns and possible side effects: Nausea occurs more frequently with ciprofloxacin than penicillin VK. Other side effects include occasional diarrhea, abdominal pain, headache, dizziness and rash. Also severe sunburn (photosensitivity) can occur in up to 1 percent of patients prescribed this drug (or any quinolone) if adequate measures of sun protection, including avoiding prolonged sun exposure and using sunscreens, are not undertaken. In patients taking the asthma drug theophylline (Theodur), ciprofloxacin and other quinolones may increase theophylline blood levels and toxicity. This interaction is potentially serious and life threatening. It is imperative to inform your dentist of all medications you are currently taking to avoid serious drug interactions.
Cipro
Ciprofloxacin
Common brand names: Cipro, Floxin
Related drug: Ofloxacin
Description: Ciprofloxacin and ofloxacin are members of the quinolone class of antibiotics and are used in medicine to treat infections of the urinary, intestinal and lower respiratory tracts, plus infections of the skin, bones and joints.
Dental uses: Ciprofloxacin is not commonly employed to treat dental infections, although its use among dentists is rising, especially among periodontists for various periodontal infections. Rare dental infections caused by the Pseudomonas species of bacteria are effectively treated by ciprofloxacin and ofloxacin.
Dosages for dental purposes: The typical adult dose of ciprofloxacin is 500 milligrams to 750 milligrams every 12 hours for seven to 10 days. Ciprofloxacin and ofloxacin (like tetracyclines) should not be ingested with dairy products (milk, yogurt), antacids (Tums, Rolaids, Maalox, Mylanta, Pepto-Bismol), or iron and zinc supplements, because these products greatly inhibit the absorption of the drugs from the gastrointestinal tract into the bloodstream.
Concerns and possible side effects: Nausea occurs more frequently with ciprofloxacin than penicillin VK. Other side effects include occasional diarrhea, abdominal pain, headache, dizziness and rash. Also severe sunburn (photosensitivity) can occur in up to 1 percent of patients prescribed this drug (or any quinolone) if adequate measures of sun protection, including avoiding prolonged sun exposure and using sunscreens, are not undertaken. In patients taking the asthma drug theophylline (Theodur), ciprofloxacin and other quinolones may increase theophylline blood levels and toxicity. This interaction is potentially serious and life threatening. It is imperative to inform your dentist of all medications you are currently taking to avoid serious drug interactions.
Chloral Hydrate
Chloral Hydrate
Common brand names: Several generics available.
Description: Chloral hydrate is a popular liquid sedative-hypnotic drug that induces sleep or sleepiness.
Dental uses: Chloral hydrate is used predominantly by pediatric dentists to calm uncooperative children. It has an unpleasant taste so it is typically mixed with Kool-Aid® or other fruit drinks before administering it to a child.
Dosages for dental purposes: The dose of chloral hydrate is based on the child’s body weight and is usually in the range of 40 milligrams per kilogram of weight to 50 milligrams per kilogram of weight (one kilogram equals 2.2 pounds). The absolute maximum dose is 1000 mg.
Concerns and possible side effects: Chloral hydrate should not be administered at home. It should only be administered in the office by practitioners (typically pediatric dentists, dental anesthesiologists and oral surgeons) who have expertise on the dosing of chloral hydrate and who have advanced training in deep-sedation techniques in children. Children receiving chloral-hydrate sedation should be appropriately monitored. While chloral hydrate is generally considered a safe drug, overdoses of chloral hydrate have resulted in several deaths. Chloral hydrate often can cause nausea and vomiting. Your dental practitioner may decide also to administer hydroxyzine (Atarax or Vistaril), an anti-emetic, to reduce this side effect. Following the dental procedure, many children will remain drowsy, uncoordinated and possibly confused for the remainder of the day. Therefore, children should be well supervised and refrain from outdoor activities.
Cevimeline
Common brand names: Evoxac
Dental uses: Cevimeline is approved for the symptomatic treatment of dry mouth (xerostomia) in patients with Sjogren’s syndrome (an immune system disease).
Dosages for dental purposes: The recommended dose of cevimeline is 30 milligrams three times per day.
Concerns and possible side effects: Patients with a chronic dry mouth are at increased risk for dental decay and should see their dentist for treatment. The most common side effects from cevimeline are sweating, runny nose, nausea, chills and excess salivation. Patients with severe asthma should not take cevimeline because cevimeline may precipitate an asthmatic attack in these individuals. Cevimeline should not be taken by patients with narrow-angle glaucoma (increased eye pressure) or acute iritis (inflammation of the iris), because cevimeline may precipitate a glaucoma attack in these individuals. Certain drugs may cause cevimeline to accumulate in the body and increase its risks of side effects. These include the antibiotics erythromycin (Eryc) and clarithromycin (Biaxin); azole antifungal drugs such as ketoconazole (Nizoral) and fluconazole (Diflucan); the ulcer medication cimetidine (Tagamet); and the antidepressants fluoxitene (Prozac), sertraline (Zoloft) and paroxitene (Paxil). This list is not complete, and it continues to grow. These interactions can be serious, so it is imperative to inform your dentist of all medications you are taking. In addition, the ingestion of grapefruit juice can also cause the accumulation of and increase the risks of side effects from cevimeline.
Cephradine
Cephalexin
Common brand names: Keflex, Biocef.
Description: Cephalexin is a cephalosporin-type antibiotic closely related to penicillins.
Dental Uses: It is occasionally used to treat dental infections that are resistant to penicillin VK. However it must be stressed that most dental infections can be better and less expensively treated with penicillin VK.
The other use of cephalexin in dentistry is to prevent joint infections in certain patients with prosthetic joints of the hip, knee or elbow who are scheduled to undergo dental procedures likely to induce mucosal or gingival bleeding. Such procedures include dental extractions, periodontal surgery, professional cleanings, orthodontic band (not bracket) placement and some other procedures.
Dosages for dental purposes: The typical adult dose of cephalexin for dental infections is 250 milligrams to 500 milligrams every six hours for seven to 10 days.
The recommended dose of cephalexin for patients at risk of joint infections is 2 grams (four 500-milligram capsules) an hour before the dental procedure. This single-dose regimen is generally well tolerated.
Concerns and possible side effects: Cephalexin produces a higher incidence of abdominal pain, diarrhea, nausea and vomiting than penicillin VK.
Approximately 10 percent of patients allergic to penicillins also are allergic to cephalosporins. Allergic reactions can range from a mild rash to life-threatening closure of the airway and a fall in blood pressure. Cephalosporins must be avoided or used with extreme caution in patients with documented penicillin allergies.
Celebrex
Celecoxib
Brand name: Celebrex
Description: Currently the largest-selling prescription drug in the United States, celecoxib was the first FDA-approved nonsteroidal anti-inflammatory drug (NSAID) that is marketed as a selective cyclooxygenase—2 (COX-2) inhibitor.
Older NSAIDs like aspirin, ibuprofen, naproxen sodium and diflunisal inhibit both COX-1 and COX-2. An inhibition of COX-2 is thought to be responsible for the ability of these drugs to relieve pain, reduce fever and lessen swelling and other symptoms of arthritis.
However, the inhibition of COX-1 is thought to be responsible for the tendency of these drugs to cause stomach and intestinal ulcers and bleeding. As a selective COX-2 inhibitor, celecoxib does not inhibit COX-1, which has resulted in about a 50-percent reduction in ulcer occurrence in arthritis patients taking it. The drug was associated with ulcers and bleeding in 2 percent of patients taking it for six months to a year, compared to a 4-percent incidence in patients taking more traditional NSAIDs, such as ibuprofen or naproxen sodium, for the same amount of time.
Bleeding ulcers can lead to hospitalization and even death. This is the major reason why many rheumatologists (arthritis specialists) and orthopedic surgeons have switched their patients to a COX-2 inhibitor.
Dental Uses: In dentistry, this lower incidence of stomach and intestinal ulcers with the long-term use of selective COX-2 inhibitors should be beneficial for patients with chronic pain of the temporomandibular joint and other types of chronic facial pain who would need to be on the drug for many weeks or months.
Currently, celecoxib is not approved for the short-term treatment of acute pain such as pain after dental surgery or toothache pain. In studies of pain after oral surgery, celecoxib 200 milligrams was an inferior pain reliever when compared to ibuprofen 400 milligrams.
Dosages for Dental Purposes: The dose of celecoxib for this use would be 100 milligrams to 200 milligrams twice each day (the same dose as for arthritis sufferers).
Concerns and Possible Side Effects: With chronic use (weeks or months), impairment of kidney function still occurs as frequently as with other NSAIDs. Abdominal pain (without ulcers) also can occur.
Patients allergic to aspirin or other NSAIDs (ibuprofen, naproxen sodium, diflunisal and many others) should not take celecoxib. In addition, patients allergic to sulfonamide drugs may also be allergic to celecoxib and should thus not take it.
Allergic reactions can range from a mild rash to life-threatening closure of the airway and a fall in blood pressure.In addition, about 5 percent to 10 percent of patients with asthma cannot tolerate aspirin, related NSAIDs or COX-2 inhibitors (including celecoxib); these drugs precipitate life-threatening asthma attacks in these so-called aspirin- or NSAID-sensitive asthmatics.
Celecoxib must be used with extreme caution in patients with a history of ulcers of the stomach or the small intestine. Patients should avoid alcohol consumption during celecoxib therapy because alcohol increases the risk of stomach ulcers and bleeding.
Other drugs with which celecoxib may adversely interact include:
The manic-depression drug lithium (Eskalith), which when combined can lead to lithium toxicity
Warfarin (Coumadin) and other anticoagulants, which can lead to bleeding Oral drugs for diabetes (ie, Diabinase and Orinase), which can lead to low blood sugar
Some high blood pressure medications, including beta blockers (propranolol, brand name Inderal), ACE inhibitors (enalopril, brand name Vasotec), and diuretics (hydrochlorothiazide, brand name Hydrodiurul). Combining any of these with celecoxib may cause elevations in blood pressure.
These interactions can be serious, so it is imperative to inform your dentist of all medications you are taking.
Biocef
Cephalexin
Common brand names: Keflex, Biocef.
Description: Cephalexin is a cephalosporin-type antibiotic closely related to penicillins.
Dental Uses: It is occasionally used to treat dental infections that are resistant to penicillin VK. However it must be stressed that most dental infections can be better and less expensively treated with penicillin VK.
The other use of cephalexin in dentistry is to prevent joint infections in certain patients with prosthetic joints of the hip, knee or elbow who are scheduled to undergo dental procedures likely to induce mucosal or gingival bleeding. Such procedures include dental extractions, periodontal surgery, professional cleanings, orthodontic band (not bracket) placement and some other procedures.
Dosages for dental purposes: The typical adult dose of cephalexin for dental infections is 250 milligrams to 500 milligrams every six hours for seven to 10 days.
The recommended dose of cephalexin for patients at risk of joint infections is 2 grams (four 500-milligram capsules) an hour before the dental procedure. This single-dose regimen is generally well tolerated.
Concerns and possible side effects: Cephalexin produces a higher incidence of abdominal pain, diarrhea, nausea and vomiting than penicillin VK.
Approximately 10 percent of patients allergic to penicillins also are allergic to cephalosporins. Allergic reactions can range from a mild rash to life-threatening closure of the airway and a fall in blood pressure. Cephalosporins must be avoided or used with extreme caution in patients with documented penicillin allergies.
Biaxin Clarithromycin
Clarithromycin
Common brand name: Biaxin.
Dental uses: Clarithromycin is an antibiotic related to erythromycin. Its main use in dentistry is in patients who are allergic to penicillins and who are at risk of developing bacterial endocarditis, a serious and potentially fatal heart infection, following dental procedures likely to induce mucosal or gingival bleeding. Such procedures include dental extractions, periodontal surgery, professional cleanings, orthodontic band (not bracket) placement and some other procedures. Patients considered at risk are those with prosthetic heart valves, those with mitral valve prolapse with valvular regurgitation (a heart murmur with leaky valves) and those who previously contracted endocarditis, in addition to people with some other cardiac conditions.
Clarithromycin also is used in patients with allergies to penicillins who have dental infections, including abscesses, infections around third molars and infections after dental surgery. It also is used in patients in whom other drugs have proved ineffective.
Dosages for dental purposes: For patients at risk for endocarditis, the recommended dose is 500 milligrams one hour before the dental procedure. For patients with dental infections, the typical dose is 250 milligrams to 500 milligrams every 12 hours for seven to 10 days.
Concerns and possible side effects: Although more expensive than erythromycin, clarithromycin is better tolerated with respect to gastrointestinal complaints (abdominal pain, nausea, vomiting and diarrhea). It does occasionally produce abnormal taste sensations.
In addition, like erythromycin, clarithromycin causes the accumulation of a number of drugs in the body if taken concurrently. These include:
The asthma drug theophylline (brand name, Theo-dur)
The non-sedating antihistamines terfenadine (brand name, Seldane) and astemizole (brand name, Hismanal)
The blood-thinning agents warfarin and dicumarol (brand name, Coumadin)
The “statin” cholesterol-lowering drugs such as lovastatin (brand name, Mevacor), simvastatin (brand name, Zocor) and atorvastatin (brand name, Lipitor)
This list is not complete, and it continues to grow. These interactions with clarithromycin are potentially serious and life threatening. It is imperative to inform your dentist of all medications you are currently taking to avoid serious drug interactions.
Azithromycin
Azithromycin
Common brand names: Zithromax
Dental uses: Azithromycin is an antibiotic related to erythromycin, with a much longer duration of action. Its main use in dentistry (like clarithromycin) is in patients who are allergic to penicillins and who also are at risk of developing bacterial endocarditis (a serious and potentially fatal heart infection) following dental procedures likely to induce mucosal or gingival bleeding. Such procedures include dental extractions, periodontal surgery, professional cleanings, orthodontic band (not bracket) placement and some other procedures. Patients considered at risk are those with prosthetic heart valves, those with mitral valve prolapse with valvular regurgitation (a heart murmur with leaky valves) and those who previously contracted endocarditis, in addition to people with some other cardiac conditions.
Azithromycin also is given to people allergic to penicillins and those who have abscesses and other dental infections, especially those extending into the sinuses, gums and bone, and for whom other antibiotics have proved ineffective.
Dosages for dental purposes: The recommended dose for preventing endocarditis is 500 milligrams one hour before the dental procedure. For penicillin-allergic patients with dental infections, azithromycin is prescribed at a dosage of 500 milligrams on the first day, and then 250 milligrams every 24 hours for a total of five days. Dosages for children are based on body weight.
Concerns and possible side effects: Although more expensive than erythromycin, azithromycin causes fewer gastrointestinal complaints such as abdominal pain, nausea, vomiting and diarrhea. So far, azithromycin has not been shown to cause the same serious drug interactions as erythromycin or clarithromycin