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Wednesday, December 11, 2013
Hypertension X Anesthetics
I have been taking propranolol 40mg for four years. Now I need to go to dentist. Can I take any kind of vasoconstrictor?
Thank you for your question. The usual vasoconstrictors used in dental local anesthetics may interact with propranolol. The possible interaction would cause a rise in blood pressure and a possible fall in heart rate.
The likelihood of this occurring is based on the doses used. Also, the seriousness of the interaction is based on your underlying medical conditions.
If your total daily dose of propranolol is 40 mg, this is a low dose. If your dose is 40 mg three times per day, this is a much higher dose with more likelihood of interaction. The amount of vasocontrictor is important too. Very low doses, when injected slowly, are unlikely to cause an interaction. So, it depends on the procedure.
For routine dentistry, usually 1 - 2 cartridges of local anesthetic are used. This can be a very low dose with 1:200,000 epinephrine containing solutions.
Slow and divided injections also reduce the general body uptake of vasoconstrictors. Local anesthetic without vasoconstrictor can also be used depending on the length of the procedure and whether it is in the upper or lower jaw.
Discuss this with your dentist. He or she will take your blood pressure and heart before and after injections to see if there is an interaction, as there may not be with the standard doses.
Additional local vasoconstrictor can be given based on your response. I hope this helps. Your dentist should be able to direct you.
Steven I Ganzberg, SB, DMD, MS
Formerly, Clinical Professor of Dentistry
College of Dentistry
The Ohio State University