A DOCS Education Member and veteran sedation dentist posts to the forum for the first time regarding a curious case involving hydroxyzine and restless legs syndrome. Faculty member Dr. Jerome Wellbrock responds with suggestions for medications and protocol.

A DOCS Education Member asks:

I have been using sedation for many years now. I use almost exclusively 5 mg of Valium® and then 0.25 mg (X3 if needed) the morning of appointment. This works perfectly 98 percent of the time. Last week I had a 120 lb, 76-year-old patient whom I needed to place implants for and perform other minor work. She told me that she couldn't take Valium® because it made her hyper. Her physician has her taking trazodone 100 mg at bedtime to sleep. I had her take that as directed by her physician, then take 25 mg of hydroxyzine in the morning, and 0.25 mg of Halcion® one hour prior to the appointment. When she got in the chair she had a lot of movement due to restless legs syndrome (RLS). Her other medications include: Estradiol 0.5 mg, Synthroid® 25 mcg, Patanase® as needed, Protonix® 40 mg, testosterone 2% aquaphor, clobetasol propionate ointment, Lexapro® and tramadol if needed for back pain. I now understand that hydroxyzine blocks the dopamine receptor and can therefore aggravate RLS. Do you have any suggestions for helping me keep this patient comfortable AND safe? Thanks in advance.

Dr. Jerome Wellbrock, DOCS Education faculty member, responds:

This is an interesting situation. Do you know if the same physician is prescribing both the trazodone and the Lexapro? This is an "X" combination according to Lexicomp® as both have a moderate (Lexapro) or high risk (trazodone) of prolonging the QT interval. The only interaction I see with the sedation medications is a "D" interaction between the hydroxyzine and Lexapro. Trazodone is not usually prescribed as a sleep aid. I did a literature search and do not find significant evidence that hydroxyzine has a strong potential to interfere with the dopamine receptors. However, there is some indication that it may have a weak catalepsy effect that should help with the restless muscles. If you could provide more information on this patient it would be helpful so I can give you additional suggestions. A detailed medical history, date and results of last physical exam, vitals at both your sedation workup and during your recent sedation appointment, including height, weight, BMI, airway classification, ASA classification, sleep habits, dietary habits or requirements, tobacco/alcohol use, etc.

Member clarifies:

I spoke with the patient's physician. It was the same physician who is prescribing both the trazodone and Lexapro. He said it was OK, but I also think that he thinks that I am overstepping my bounds by even asking. But he did say it's OK. He is prescribing Requip® for her RLS and said it should help. I'll get the rest of the information you asked about. Thanks again.

Wellbrock responds:

Naturally the physician thinks you are overstepping your bounds because you asked an intelligent question about your mutual patient. The reply should have been that the physician appreciates your concern about this patient. He should be thinking, "WOW, here is a dentist who is on the ball and doing his homework before sedating the patient!"

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.

issue_no
0
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.
DOCS Membership

Upcoming Events
Streaming
May 17- 18, 2024
Atlanta, GA skyline
GA
August 23- 24, 2024
Streaming
October 04- 05, 2024

More Articles