A DOCS Education member brings this question to the forum:
I would appreciate some input regarding this patient, a 56 year old female, 5 feet and 1.5 inches tall, 248 lbs. She is a non-smoker. I have an upcoming treatment appointment with her and I plan on using a Triazolam titration protocol with her starting with .25 mg of Triazolam one hour prior to her appointment. She reports the following medical conditions:
- Hypertension
- Diabetes
- Asthma
- Hay Fever
- Hypothyroidism
- Fibromyalgia
Her current medications include the following:
- Oxycodone - fibromyalgia (daily for breakthrough pain)
- Klonopin ® - fibromyalgia
- Synthroid ® - hypothyroidism
- Lasix ® - hypertension
- Inkovana™ - diabetes
- Nexium ® - reflux
- Zofran ® - nausia (prn)
- Ambien ® - sleep aid (prn)
- Symbicort ® - asthma (prn)
- Beconase ® - nasal spray (prn)
- Lexapro ® - pain management / depression
She reports allergy/adverse reaction with the following:
- Aspirin
- Cymbalta ®
- Claritin ®
- Statin Drugs
- Most Insulins
A Lexicomp Interaction Analysis for Triazolam revealed the following:
- D – Ambien ®
- C – Lexapro ®
- C – Nexium ®
- C – Oxycodone
Her treatment appointment will be approximately three hours long. The patient says that she cannot go long periods of time without her Oxycodone due to fibromyalgia pain, therefore she would prefer not to discontinue taking the medication. What would you suggest as far as stopping the drug for oral sedation with Triazolam? Should she discontinue any of her other medications? Thank you.
Dr. Jerome Wellbrock, Live Patient Experience Director at DOCS Education, responds:
You certainly have some tough patients today. As for the patient in question, I would not sedate her. Red flags are going up all over the place. She has a lot of medical issues that do not seem to be under control. As this is such a tricky case, I would recommend considering a referral where anesthesia personnel can provide the sedation while you perform the dentistry.
The DOCS Education member replies:
Dr. Wellbrock,
I sincerely appreciate your response. I will heed your advice. For future reference, should a patient discontinue the Oxycodone when being sedated with Triazolam? Thank you
Dr. Wellbrock clarifies:
The fact that a patient is taking opiod/narcotic analgesics does not automatically disqualify them from being sedated in the office, nor must they always cease the medications. You have to consider the patients overall health and medical conditions, any physical limitations such as weight and airway, the total amounts and types of medications being taken, etc.
