6. Neurological Drugs and Psychotropics
💊 First-Line Antiepileptic Drugs
This table outlines the primary first-line medications for various seizure types.
| Seizure Type | First-Line Drug(s) |
|---|---|
| Focal (Partial) Seizures | Carbamazepine |
| Generalised Tonic-Clonic | Valproate |
| Absence Seizures | Ethosuximide, Valproate |
| Myoclonic Seizures | Valproate |
| Special Consideration¹ | Lamotrigine, Levetiracetam |
¹ May be considered first-line for focal and generalised tonic-clonic seizures in females of child-bearing potential.
⚠️ Adverse Drug Reactions (ADRs) Relevant to Dentistry
Many antiepileptic drugs share side effects that can impact dental treatment. Below are common ADRs and the specific drugs associated with them according to the provided text.
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Drowsiness, Dizziness, and Ataxia (impaired coordination): These are common and can affect patient stability.
- Drugs causing these include: Barbiturates, Benzodiazepines, Gabapentinoids (Gabapentin, Pregabalin), Carbamazepine, Ethosuximide, Lamotrigine, Levetiracetam, Oxcarbazepine, Phenytoin, Topiramate, and Valproate.
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Dry Mouth (Xerostomia): This increases the risk for dental caries.
- Drugs causing this include: Benzodiazepines, Gabapentinoids, and Carbamazepine.
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Motor Disturbances: These can interfere with patient cooperation and procedures.
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Tremor: Caused by Gabapentinoids, Oxcarbazepine, and Valproate.
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Nystagmus (involuntary eye movements): Caused by Oxcarbazepine, Phenytoin, and Topiramate.
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Orofacial Dyskinesia (involuntary facial movements): A rare side effect of Carbamazepine.
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Salivary Changes:
- Hypersalivation (drooling): Can be a paradoxical side effect of Benzodiazepines, potentially complicating restorative work.
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Taste Disturbances: This can be caused by Topiramate.
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Serious Skin Reactions: Rare but severe reactions like Stevens-Johnson Syndrome (SJS) can manifest on the face and oral mucosa.
- Drugs with this rare risk include: Barbiturates, Gabapentinoids, Carbamazepine, Ethosuximide, Lamotrigine, Levetiracetam, Oxcarbazepine, and Phenytoin.
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Gingival Hyperplasia: A well-known side effect that complicates oral hygiene, specifically associated with Phenytoin.
🦷 Key Dental Considerations
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Pharmacological Interactions
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CNS Depressants: Avoid co-prescribing other CNS depressants, as this can worsen sedation.
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CYP3A4 Enzyme: Be aware that some antiepileptics (like phenobarbital) are potent inducers of the CYP3A4 enzyme, which can reduce the effectiveness of other drugs, including metronidazole.
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Patient Management
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Chair Positioning: Due to common side effects like drowsiness and dizziness, always provide assistance to patients when they are moving into or out of the dental chair.
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Appointment Timing: It is best to schedule appointments when the patient’s medication levels are most optimal to reduce the risk of a seizure.
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Procedural Aids: For patients with motor disturbances like tremors, procedural difficulty can be anticipated for tasks like taking radiographs. For hypersalivation, the use of a rubber dam is recommended to maintain a dry field for restorations.
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