A 91-year-old patient is taking 500 mg of amoxicillin leading up to a sedation appointment and is experiencing dizziness. The patient is allergic to penicillin. A DOCS Education Member seeks the advice of DOCS Education faculty for next steps.

A DOCS Education Member inquires:

A 91-year-old patient has been taking amoxicillin 500 mg since Thursday, July 23. Her daughter called on July 28 and said the patient has been light-headed since she has been taking the medication. She was curious if this was a side effect.

The patient is also taking Crestor® 10 mg, diltiazem 120 mg and esomeprazole. She has high blood pressure, mitral valve prolapse and is allergic to latex and penicillin.

She is scheduled to have two teeth extracted. Research literature (i.e. www.ehealthme.com) makes reference to a study in which dizziness is a side effect of amoxicillin. We ran the drug combinations through Lexicomp; the only interaction was noted as a "C" (recommended monitoring).

Please provide your recommendations for either continuation of amoxicillin until surgery is done, or ceasing immediately with any. Also include your thoughts on the study on ehealthme.com.

Thank you for your consideration.

Dr. Anthony S. Feck, DOCS Education Dean of Faculty, responds:

Dizziness is listed as a side effect of amoxicillin in Lexicomp, but this does not mean the amoxicillin is causing the dizziness. You can certainly change the antibiotic and see if the dizziness dissipates. As always, a medical consult is a good idea to address medical-related concerns.

Some questions to consider:

  • How significant is the dizziness, i.e. how does it impair normal activity? If the dizziness is mild, then it may be a non-issue if the patient is carefully monitored.
  • What are the patient's baseline vitals? If the BP is low, then dizziness may just as well be related to this.
  • When was the last time the patient had a medical evaluation? For a 91-year-old, it should have been within the last six months.

Dr. Jerome Wellbrock, DOCS Education faculty member, also provides insight:

This has nothing to do with her dizziness, but I assume she has no allergic cross-sensitivity to amoxicilin. I would usually go to an alternative antibiotic for patients with a penicillin allergy.

Disclaimer

The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.

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The information contained in this, or any case study post in Incisor, should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 3250 Airport Way S, Suite 701 | Seattle, WA 98134. Please print a copy of this posting and include it with your question or request.
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