This summary is based on the Clinical Info provided by the Canadian Pharmacists Association: Drugs in Dentistry (December 2012)
By Dr. Dan Haas, DDS, PhD, FRCDC
Consider the following points in the use of analgesics:
- Eliminate the source of pain, if possible.
- Individualize regimens.
- Optimize dose and frequency before switching.
- Maximize the nonopioid before adding the opioid.
- Consider a loading dose and/or a preoperative dose for nonsteroidal anti-inflammatory drugs (NSAIDs).
- Avoid chronic use of any analgesic.
- Reduce the dose in older individuals.
Be aware of the contraindications and cautions for NSAIDs, including ASA (see also individual product monographs and CPhA monographs as well as comprehensive drug interaction references).
Avoid NSAIDs in patients with:
- History of allergic reaction to any NSAID, including ASA.
- ASA-induced asthma and nasal polyps.
- Inflammatory bowel disease (Crohn’s disease, ulcerative colitis).
- History of bleeding disorder or concurrent use of anticoagulants.
- Concurrent use of antineoplastic doses of methotrexate.
- Concurrent use of lithium.
- Concurrent use of digoxin in older individuals or those with renal disease.
- For ASA: concurrent use of sulfonylurea oral hypoglycemics.
Avoid or use NSAIDs with caution, for the shortest possible time, in patients with:
- History of myocardial infarction or stroke.
- Concurrent use of ACE inhibitors, loop diuretics or beta-blockers, particularly in patients with heart failure (avoid NSAIDs or limit use to ≤4 days).
Be aware of the contraindications and cautions for opioids:
- Severe respiratory disease.
- Severe inflammatory bowel disease.
- Concurrent use of alcohol or other CNS depressants.
Analgesics for Orofacial Pain: Pediatric Doses
Analgesics for Orofacial Pain: Adult Doses
Resources
- Haas DA. Adverse drug interactions in dental practice: interactions associated with analgesics, Part III in a series. J Am Dent Assoc 1999;130(3):397-407.
- United States Pharmacopeial Convention. USP DI Volume 1: Drug information for the health care professional. 24th ed. Englewood (CO): Micromedex; 2004.
- Haas DA. An update on analgesics for the management of acute postoperative dental pain. J Can Dent Assoc 2002;68(8):476-82.
- Trelle S, Reichenbach S, Wandel S et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ 2011;342:c7086.
- F Salvo, A Fourrier-Réglat, F Bazin et al. Cardiovascular and gastrointestinal safety of NSAIDs: a systematic review of meta-analyses of randomized clinical trials. Clin Pharmacol Ther 2011;89(6):855-66.
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