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Dental Anesthesia

Beta Blockers in Heart Disease

09/28/2010

Question:

Is using Citanest safe when I am already taking a beta blocker?

Answer:

Citanest, a brand name for prilocaine, is fine with beta blockers. In fact, all local anesthetics are fine with local beta blockers. There is some concern with lidocaine metabolism being slowed, but as long as very high doses are not used, which is very uncommon for routine dentistry on adults, this is not a concern.

There is a concern with some beta blockers and drugs that are added to some local anesthetics to increase duration and effectiveness.

These drugs are epinephrine and levonordefrin. When used in combination with non-selective beta blockers, a special group including propranolol, timolol, nadalol, pindolol, sotolol and others, there can be an interaction causing high heart rate and low blood pressure.

This is unlikely to occur with the small doses used in routine dental care but the dentist can monitor for this and take precautions.

This interaction is not likely to occur with cardioselective beta blockers, such as metoprolol and atenolol, or with combined alpha and beta blockers such as carvedilol.

Good luck!

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Response by:

Steven I Ganzberg, SB, DMD, MS Steven I Ganzberg, SB, DMD, MS
Formerly, Clinical Professor of Dentistry
College of Dentistry
The Ohio State University