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Dr. Bob is Robert Hsiung, MD,
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Posted by Tony P on February 7, 2008, at 17:49:06
I cancelled a dentist appointment today because of concerns (confirmed by my pharmacist) about interactions between my selegeline MAOI (oral 10 mg) and the freezing (which contains epinephrine plus novocaine or some of the newer equivalents), which could lead to a hyertensive crisis.
I'm wondering if anyone has experience or more specific info on this particular combo. I found a couple of old references to the risk of MAOIs, but not much on selegeline/EMSAM, which seems to be safer than most. I've tried (very cautiously & checking my BP!) taking decongestants (phenylephrine or sudafed) in normal doses and got only a very small rise in BP if any. But I'm concerned about the unkown effect of the dentist's combo of meds in the anesthetic.
I understand anesthetics without any epinephrine are available & I've left a message with my dentist's office asking about that. I don't know about the XXX-ocaine itself, though.
My pharmacist suggested stopping the selegeline for 24 hr prior, but my understanding is that (as an "irreversible" MAOI) the washout period should be 2 weeks or more. I'm reluctant to stop it for that long, though, when I'm getting good results from it.
I've got a new appointment with the dentist for about 2 1/2 weeks from now, so if I'm going to stop the selegeline for two weeks to be safe, I need to do it almost immediately.
Any suggestions would be much appreciated!
Tony
Posted by Larry Hoover on February 7, 2008, at 18:22:47
In reply to Selegeline/EMSAM + dentist - risk from freezing?, posted by Tony P on February 7, 2008, at 17:49:06
> I understand anesthetics without any epinephrine are available & I've left a message with my dentist's office asking about that. I don't know about the XXX-ocaine itself, though.
Absolutely true. Adrenaline is used as a vasoconstrictor, and extends the action of the anaesthesia, and reduces bleeding. It's not necessary to get a local with adrenaline. It's just the common way of doing things.
There are two newer drugs, mepivicaine (Carbocaine) and prilocaine (Citanest), that can be used without the adrenaline vasoconstrictor. They are used for patients taking beta blockers and tricyclic antidepressants (and MAOIs), because of the known interactions. Perhaps your dentist is unfamiliar with the MAOI interaction, but he should know about the tricyclic/beta-blocker issue.....the remedy is the same.
Also, there's always nitrous oxide. Or lidocaine (Xylocaine) without epinephrine. But the two -caines I first mentioned are the best options.
You don't need to go off the selegeline.
Lar
Posted by Tony P on February 9, 2008, at 3:55:53
In reply to Re: Selegeline/EMSAM + dentist - risk from freezing? » Tony P, posted by Larry Hoover on February 7, 2008, at 18:22:47
Thanks, Lar, that's reassuring! I've passed the info on to my dentist. I haven't had a chance to talk to him yet, but I am sure he must be knowledgeable about these things; he's been around long enough to go back to the period when MAOI's were fairly common.
Cheers,
Tony
This is the end of the thread.
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