口腔科药物间及与膳食补剂间的相互作用

口腔科常用的一些药物可能和患者正在使用的药物以及膳食补剂等发生相互作用而产生不良后果，下表摘自第二版的The ADA Practical Guide to Patients with Medical Conditions.

1. 口腔科药物可能和患者正在使用的药物发生相互作用

患者正在使用的药物	口腔科开具的药物	相互作用后果
抗微生物药·Antimicrobial Drugs
酒精·Alcohol	甲硝唑·Metronidazole	Disulfuram‐like reaction of nausea, vomiting, headache, flushing
抗酸药和铁剂·Antacids and iron supplements	四环素类·Tetracyclines	Loss of antibacterial action of tetracyclines
阿托伐他汀，辛伐他汀，普伐他汀·Atorvastatin, simvastatin, pravastatin	红霉素，克拉霉素·Erythromycin, clarithromycin	Increased statin level precipitating possible muscle weakness and breakdown
卡马西平·Carbamazepine	红霉素，克拉霉素，多西环素，伊曲康唑，酮康唑·Erythromycin, clarithromycin, doxycycline, itraconazole, ketoconazole	Increased risk of carbamazepine toxicity
环孢菌素·Cyclosporin	氟康唑，伊曲康唑，酮康唑，两性霉素，克拉霉素·Fluconazole, itraconazole, ketoconazole, amphotericin, clarithromycin	Increased risk of nephrotoxicity
地高辛·Digoxin	红霉素，四环素类，伊曲康唑，克拉霉素·Erythromycin, tetracyclines, itraconazole, clarithromycin	Digoxin toxicity
锂剂·Lithium	甲硝唑，四环素·Metronidazole, tetracycline	Increased lithium toxicity
甲胺喋呤·Methotrexate	青霉素类·Penicillins	Methotrexate toxicity
咪达唑仑和其他苯二氮卓类·Midazolam and other benzodiazepines	红霉素，克拉霉素，酮康唑，伊曲康唑·Erythromycin, Clarithromycin, ketoconazole, Itraconazole	Profound sedation
口服避孕药·Oral contraceptives	阿莫西林，红霉素，四环素类，甲硝唑，氨苄西林，（可能还有其他一些抗生素）Amoxicillin, erythromycin, tetracyclines, metronidazole, ampicillin, possibly other antibiotics	Contraceptive failure (low risk). (Patient should discuss with physician additional nonhormonal contraception use during antibiotic use and subsequent week
苯妥英钠·Phenytoin	氟康唑，酮康唑，甲硝唑·Fluconazole, ketoconazole, metronidazole	Increased plasma levels of phenytoin
氨茶碱·Theophylline	红霉素，克拉霉素，酮康唑，伊曲康唑·Erythromycin, clarithromycin, ketoconazole, itraconazole	Theophylline toxicity
华法林·Warfarin	红霉素，甲硝唑，四环素类，酮康唑，克拉霉素，头孢菌素类·Erythromycin, metronidazole, tetracyclines, ketaconazole, clarithromycin, cephalosporins	Enhanced anticoagulation effect
抗炎药/Anti‐inflammatory Drugs
酒精·Alcohol	阿司匹林·Aspirin	Increased risk of damage to gastric mucosa
卡托普利和其他ACEi制剂·Captopril, other ACE inhibitors	阿司匹林，布洛芬·Aspirin, ibuprofen	Reduction in antihypertensive effect
皮质类固醇·Corticosteroids	阿司匹林·Aspirin	Risk of salicylate toxicity on steroid withdrawal; increased risk of damage to gastric mucosa
环孢菌素·Cyclosporin	阿司匹林，非甾体类抗炎药·Aspirin, NSAIDs	Increased risk of nephrotoxicity
地高辛·Digoxin	阿司匹林，布洛芬·Aspirin, ibuprofen	Digoxin toxicity
肝素，华法林·Heparin, warfarin	阿司匹林，非甾体类抗炎药·Aspirin, NSAIDs	Risk of hemorrhage
胰岛素，氯磺丙脲和其他降糖药·Insulin, chlorpropamide, other hypoglycemics	阿司匹林·Aspirin	Risk of hypoglycemia
锂剂·Lithium	布洛芬，萘普生，塞来昔布·Ibuprofen, naproxen, celecoxib	Lithium toxicity
甲胺喋呤·Methotrexate	阿司匹林，布洛芬，萘普生·Aspirin, ibuprofen, naproxen	Methotrexate toxicity
苯妥英钠·Phenytoin	阿司匹林，非甾体类抗炎药·Aspirin, NSAIDs	Increased plasma levels of phenytoin
丙戊酸（抗癫痫药）·Valproic acid	阿司匹林·Aspirin	Risk of hemorrhage; increased valproate toxicity
其他药物·Other Drugs
酒精，镇静性H1受体拮抗肌，抗精神病药物，抗癫痫药·Alcohol, sedative H1 antagonists, neuroleptics, antiepileptics	地西泮·Diazepam	Excessive sedation; impaired psychomotor skills; possible respiratory depression
左旋甲状腺素·Levothyroxine	肾上腺素·Epinephrine	Coronary insufficiency in patients with coronary artery disease
普萘洛尔和其他beta受体阻滞剂·Propranolol, other beta blockers	肾上腺素·Epinephrine	Marked hypertension and reflex bradycardia
三环抗忧郁剂·Tricyclic antidepressants	肾上腺素·Epinephrine	Hypertensive reaction and possible cardiac arrhythmias

2. 口腔科药物可能和患者正在使用的膳食补剂发生相互作用

膳食补剂-口腔科药物·Dietary Supplement–Dental Drug	潜在相互作用能力·Potential Interaction	影响·Implication
钙剂·Calcium
+多西环素··Doxycycline	Moderate	Reduced anti‐infective effectiveness
+四环素·Tetracycline	Moderate	Reduced anti‐infective effectiveness
夜来香（月见草油）Evening Primrose (Oenothera biennis)
+阿司匹林·Aspirin	Moderate	Enhanced bleeding
+布洛芬·Ibuprofen	Moderate	Enhanced bleeding
银杏叶提取液·Ginko biloba extract
+阿司匹林·Aspirin	Major	Enhanced bleeding
+布洛芬·Ibuprofen	Major	Enhanced bleeding
金丝桃·St. John’s wort (H. perforatum)
+阿奇霉素·Azithromycin	Major	Possible photosensitivity reactions
+苯二氮卓类·Benzodiazepines	Major	Reduced benzodiazepine effectiveness
+克拉霉素·Clarithromycin	Major	Reduced anti‐infective effectiveness
+克林霉素·Clindamycin	Major	Reduced anti‐infective effectiveness
+可待因·Codeine	Major	Increase narcotic‐induced sleep time and analgesia
+地塞米松·Dexamethasone	Major	Reduce dexamethasone effectiveness
+苯海拉明·Diphenhydramine	Major	Possible photosensitivity reactions
+多西环素·Doxycycline	Major	Reduced anti‐infective effectiveness and Possible photosensitivity reactions
+红霉素·Erythromycin	Major	Reduced anti‐infective effectiveness
+氢考酮·Hydrocodone	Major	Increase narcotic‐induced sleep time and analgesia
+布洛芬·Ibuprofen	Major	Possible photosensitivity reactions
+羟考酮·Oxycodone	Major	Increase narcotic‐induced sleep time and analgesia
+泼尼松·Prednisone	Major	Reduced prednisone effectiveness
+四环素·Tetracycline	Major	Reduced anti‐infective effectiveness
+扎莱普隆（新一代非苯二氮苣类镇静催眠药）Zaleplon	Major	Reduced zaleplon effectiveness
+唑吡坦·Zolpidem	Major	Reduced zaleplon effectiveness
缬草根（从缬草根提取的镇定药）Valerian
+苯二氮卓类·Benzodiazepines	Major	Excess sedation
+可待因·Codeine	Major	Excess sedation
+苯海拉明·Diphenhydramine	Major	Excess sedation
+氢考酮·Hydrocodone	Major	Excess sedation
+羟考酮·Oxycodone	Major	Excess sedation
+扎莱普隆·Zaleplon	Major	Excess sedation
+唑吡坦·Zolpidem	Major	Excess sedation

Major: high severity and probable occurrence;
Moderate: moderate severity and probable occurrence or high severity and possible occurrence.