Table 3.

Common psychotropic medications and their interactions with sedative or aneasthetic drugs.

Psychotropic Medication/Purpose	Examples	Interacting Dental Drug18	Interaction effects18	Recommendations18
Anticonvulsants Bipolar Disorder	Carbamapezine Lamotrigine Valproic acid	Barbiturates	May decrease metabolism of barbiturates, increasing plasma concentrations	Monitor for excessive phenobarbital effect
Benzodiazepines Anxiety	Alprazolam Diazepam Midazolam	Barbiturates	May increase sedative effects	Observe patient for increased CNS depression; decrease dosage of benzodiazepine if necessary
		Benzodiazepines (other)	May increase sedative effects	Observe patient for increased CNS depression; decrease dosage of benzodiazepine if necessary
		Opioids	Increased risk of respiratory depression and hypotension, and increased recovery time	Monitor for excessive sedation and titrate dosages as necessary
Mono-amine oxidase inhibitors Depression	Phenelzine Tranylcypromine	Opioids	Meperidine given with MAOI can cause severe hypertension, agitation, seizures, fever, apnea, coma, death	Avoid combining meperidine and MAOI medications
		Barbiturates	May increase sedative effects	Consider reducing dosage of barbiturate
Selective serotonin reuptake inhibitors Depression/anxiety	Fluoxetine Paroxetine Sertraline Citalopram	Opioids	Meperidine with SSRI medications may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.	Do not give meperidine to patients taking SSRI medication
Serotonin- norepinephrine reuptake inhibitors Depression/anxiety	Venlafaxine Mirtazapine Duloxetine	Opioids	Meperidine with SNRI medications may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.	Do not give meperidine to patients taking SNRI medication
Stimulants Attention disorders	Methylphenidate	Opioids	Meperidine given with amphetamines can cause hypotension and respiratory collapse	Do not give meperidine to patients taking amphetamines