A DOCS Education member seeks the faculty’s assistance:

I have a 35-year-old patient who has Cerebral Palsy, is intellectually disabled and a history of seizures. He is taking the following medications: Remeron®, Dilantin®, Clonazepam and Keppra.

We have sedated the patient in the past with triazolam with fair to good success. In the past Lexicomp did not show a "D" interaction with any of the medications. I noticed that running the Lexicomp today showed a "D" interaction with Dilantin®.

Any suggestions on whether to proceed or not? Any help would be appreciated.

The DOCS Education member adds:

 

Dilantin-Triazolam Interaction

Thank you, Dr. Feck.

Dr. Anthony Feck, DOCS Education faculty, responds:

Dilantin is a CYP-450 enzyme inducer, enhancing metabolism of substrates of that enzyme complex. This isn't as much of a safety concern when using those substrates (eg. diazepam, triazolam) as it is a therapeutic concern. There is an increased concern that diazepam and triazolam will not be as effective as desired.

However, since you have sedated this patient on these medications before with success, you can justify proceeding as before. If the patient should hyporespond to the point that they are not comfortable and/or their TOP dose is reached, you should consider eliminating the diazepam the night before and using a lorazepam or lorazepam/hydroxyzine protocol instead of a triazolam protocol.

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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