Interações medicamentosas de interesse em odontologia / Drug interactions of interest in dentistry

Objetivo: evidenciar a importância do conhecimento farmacológico na odontologia e identificar as principais interações medicamentosas que podem ocorrer nesse âmbito, fornecendo informações para uma prescrição mais segura e eficaz. Revisão de literatura: foi possível observar que as classes mais prescritas na prática odontológica são os anti-inflamatórios não esteroidais (Aines), antibióticos e analgésicos. As interações mais expressivas em relação aos Aines são com anticoagulantes, provocando aumento de risco de sangramento, fármacos anti-hipertensivos, reduzindo a eficácia anti-hipertensiva, e Lítio, aumentando a toxicidade dessa droga; além disso, podem interagir com fármacos como Efavirenz ou Naltrexona, potencializando risco de lesão hepática. Para antibióticos, as interações mais comuns são: com etanol, podendo ocasionar reação tipo dissulfiram; com Etinilestradiol, comprometendo a eficácia contraceptiva; além de interações importantes com anticoagulantes, Isotretinoina e Metotrexato. Opioides associados a benzodiazepínicos ou a outros depressores, como a Amitriptilina, podem resultar em profunda sedação; interações com a Fluoxetina podem diminuir a analgesia. Considerações finais: há significativa possibilidade de interações medicamentosas na odontologia, podendo comprometer a saúde dos pacientes, sendo importante o conhecimento do cirurgião-dentista sobre as possíveis interações e seus potenciais riscos, a fim de evitar complicações durante o tratamento.(AU)

Objective: to highlight the importance of pharmacological knowledge in dentistry and to identify the main drug interactions that may occur in this area, providing information for a safer and more effective prescription. Literature review: It is possible to observe that the most prescribed classes in dental practice are NSAIDs, antibiotics and analgesics. The most significant interactions with NSAIDs occur with anticoagulants (which cause increased risk of bleeding), antihypertensive drugs (which reduce anti-hypertensive efficacy) and lithium, which increase the toxicity of this drug. In addition, NSAIDs may interact with drugs such as Efavirenz or Naltrexone, which increase the risk of liver damage. For antibiotics, the most common interactions take place with ethanol, (which may lead to disulfiram-like reactions), ethinyl estradiol (which compromise contraceptive efficacy); in addition to important interactions with anticoagulants, isotretinoin and methotrexate. Opioids, associated with benzodiazepines or other depressants such as amitriptyline, may result in heavy sedation; while interaction with fluoxetine may decrease analgesia. Final considerations: there is a significant possibility of drug interactions in dentistry, which may compromise patients' health. The dental surgeon's knowledge about possible interactions and their potential risks is important in order to avoid complications during treatment.(AU)

Investigation of possible teratogenic effects in the offspring of mice exposed to methylphenidate during pregnancy.

Methylphenidate (MPH) is a central nervous system stimulant drug that increases concentration and energy level. The safety of MPH use during pregnancy is not well established. Considering the high rate of unplanned pregnancy among young women, potential for accidental exposure to MPH in early pregnancy is high. This study aimed to investigate if MPH administered during pregnancy would induce maternotoxicity, teratogenicity in mice, or both. Pregnant Swiss mice were treated with MPH (5 mg/kg, subcutaneously) or 0.9% saline (control group) from the 5th to the 17th day of pregnancy. In the MPH-treated group, a significant increase in the total number of resorptions with a consequent increase in post-implantation loss and a decrease in fetal viability were detected (all P < 0.05). A total of 91.43% of resorptions were classified as early resorptions. The group treated with MPH presented significant external (polydactyly P < 0.01), skeletal (incomplete ossification of the skull P < 0.01) and visceral (dilated ventricles P < 0.05) malformations. Behavioural effects (motor activity, memory of habituation and anxiety) were not observed in both male and female offspring evaluated at postnatal days 22, 35 and 75. The results suggest that MPH is an embryotoxic and teratogenic drug.

Passiflora incarnata treatment during gestation and lactation: toxicological and antioxidant evaluation in wistar dams

Passiflora incarnata is marketed in many countries as a phytomedicine. Even though the directions of most marketed phytomedicines recommend them to be used under medical supervision, reproductive and developmental studies are sparse and not mandatory for regulatory purposes. In this study, a reproductive toxicity evaluation of P. incarnata was conducted in Wistar rats gavaged (30 or 300 mg/kg) during pregnancy and lactation. Moreover, considering that antioxidant properties have been attributed to flavonoids present in the genus Passiflora, it was also evaluated the antioxidant/pro-oxidant balance in the plasma of these dams and the antioxidant potential in an in vitro test. P. incarnata treatment did not influence dams´ body weight as well as reproductive (gestation length, post-implantation loss, litter size, litter weight) and hepatic (albumin, AST, ALT, GGT) parameters. The antioxidant property of P. incarnata was evidenced both in vivo (increase in the total antioxidant plasmatic potential) and in vitro (decrease in neutrophil-induced respiratory burst). The results from the present study indicate that under the experimental conditions evaluated, P. incarnata treatment during gestation and lactation presented antioxidant activity in the absence of maternal reproductive toxicity.

Passiflora incarnata é comercializada em muitos países como fitoterápico. Embora a bula da maioria dos fitoterápicos recomende que eles sejam usados sob supervisão médica, estudos sobre a toxicidade reprodutiva e do desenvolvimento desses produtos são raros e não obrigatórios para fins regulatórios. Neste estudo, realizamos uma avaliação da toxicidade reprodutiva da P. incarnata, administrada a ratas Wistar (30 ou 300 mg/kg, gavagem) durante a gestação e a lactação. Além disso, considerando as propriedades antioxidantes que têm sido atribuídas aos flavonoides presentes no gênero Passiflora, também avaliou-se o equilíbrio antioxidante/pró-oxidante no plasma destas fêmeas e conduziu-se um teste in vitro para avaliar o potencial antioxidante. O tratamento com P. incarnata não influenciou o peso corporal das fêmeas, bem como indicadores de toxicidade reprodutiva (perdas pós-implantação, número de filhotes vivos e peso da ninhada) e os parâmetros de função hepática (albumina, AST, ALT, GGT). A propriedade antioxidante da P. incarnata foi evidenciada tanto in vivo (aumento do potencial antioxidante total plasmático) quanto in vitro (diminuição do burst respiratório em neutrófilos). Os resultados deste estudo indicam que, nas condições experimentais avaliadas, o tratamento com P. incarnata durante a gestação e lactação apresentou efeito antioxidante, na ausência de toxicidade reprodutiva materna.

Could maternal exposure to the antidepressants fluoxetine and St. John's Wort induce long-term reproductive effects on male rats?

Based on the limited number of studies that have investigated the adverse effects of maternal treatment with antidepressants on the development of male descendents, this study was carried out in rat in order to evaluate if maternal exposure to fluoxetine (FLX) or St. John's Wort (SJW) could disrupt the development of male offspring. The dams were treated daily, by gavage, with 7.5 mg/kg of FLX or 100 mg/kg SJW during pregnancy and lactation. The reproductive and behavior parameters were analyzed in male pups. Results showed decreases in the weight of the full seminal vesicle and in the number of spermatozoa. Moreover, FLX-exposed pups presented reduced seminiferous epithelium height and diameter of seminiferous tubules. The present study shows that maternal exposure to FLX, but not SJW could interfere on reproductive parameters in adult male rats.