Drug interactions in dentistry
Abstract
Background The hepatic and intestinal cytochrome, or CY, P450 enzyme system is responsible for the biotransformation of a multitude of drugs. Certain medications used in dentistry can act as substrates, inducers or inhibitors of this system. Methods The authors conducted a MEDLINE search of articles appearing between 1976 and the present using the keywords "drug interactions" and "cytochrome P450," and reviewed reports involving dental therapeutic agents using PubMed links from an Indiana University CYP450 drug interaction table on the World Wide Web. Results The antibiotics erythromycin and clarithromycin are potent inhibitors of CYP3A4 and can increase blood levels and toxicity of CYP3A4 substrates. Likewise, quinolone antibiotics such as ciprofloxacin inhibit the metabolism of CYP1A2 substrates. Other dental therapeutic agents are substrates for CYP2C9 (celecoxib, ibuprofen and naproxen), CYP2D6 (codeine and tramadol), CYP3A4 (methylprednisolone) and CYP2E1 (acetaminophen). Because codeine and tramadol are prodrugs, inhibition of their metabolism can lead to a diminution of their analgesic effects. While inducers of acetaminophen metabolism, including alcohol, theoretically can increase the proportion of it that is biotransformed into a potentially hepatotoxic metabolite, recent research suggests that concomitant alcohol intake does not increase the hepatotoxic potential of therapeutic doses of acetaminophen. Conclusions A number of clinically significant drug interactions…
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In oral surgery, assessment of potential DDIs is a time-critical clinical judgment often made under pressure, frequently while patients are still in the chair and the surgical team must decide within minutes whether to proceed, substitute, adjust or defer treatment.
“In oral surgery, the assessment of potential drug-drug interactions is not a leisurely academic exercise but a time-critical clinical judgment often made under pressure, frequently while patients are still in the chair and the surgical team must decide within minutes whether to proceed, substitute, adjust or defer treatment [21,22].”
From Comparing Artificial Intelligence (ChatGPT, Gemini, DeepSeek) and Oral Surgeons in Detecting Clinically Relevant Drug–Drug Interactions in Dental Therapy (2025) · cites this paper as [21]
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Rhabdomyolysis from the Coadministration of Lovastatin and the Antifungal Agent Itraconazole
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Tayeb, S., Barausse, C., Pellegrino, G., Sansavini, M., Pistilli, R., & Felice, P. (2025) · Applied Sciences · doi:10.3390/app152312851 · Cited by 12 · see citing works
- Authors
- HERSH, E. V., & MOORE, P. A.
- Affiliations
- University of Pennsylvania (US)
- Corresponding author
- HERSH, ELLIOT V.
- Venue
- The Journal of the American Dental Association
- Publisher
- Elsevier BV
- Published
- 2004-03
- Volume
- 135
- Issue
- 3
- Pages
- 298-311
- ISSN
- 0002-8177 (ISSN-L)
- OpenAlex
- W2291583090
- Cited by
- 78
- References
- 3
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2 · 2023: 1 · 2022: 2 · 2020: 4 · 2019: 1 · 2018: 4 · 2017: 1 · 2016: 2 · 2015: 2 · 2014: 5 · 2013: 4 · 2012: 7
- FWCI
- 0.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of the American Dental Association (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Keywords
- drug interactions, cytochrome P450, CYP3A4 inhibitors, erythromycin, clarithromycin, CYP1A2 inhibition, ciprofloxacin, CYP2C9, CYP2D6, codeine, tramadol, paracetamol, alcohol, polypharmacy, drug metabolism, adverse drug reactions
- MeSH terms
- Cytochrome P-450 Enzyme System, Dental Care, Drug Interactions, Enzyme Induction, Humans, Pharmacokinetics, Substrate Specificity, Drug-Related Side Effects and Adverse Reactions, Cytochrome P-450 Enzyme Inhibitors
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