Irish Medicines Formulary (IMF)

Do Irish dentists need IMF?

IMF_29Dentists may not prescribe medicines as frequently as medical doctors do, but when they do prescribe, the importance of safety is the same. Perhaps more importantly, dentists need reliable knowledge about medicines their patients may already be taking and which may complicate dental procedures or contribute to deteriorating oral health (1 in 5 people over 50 years of age in Ireland are taking 5 or more medicines). In both cases, having an up to date IMF in the practice ensures rapid access to key medicines prescribing and safety information.

Some medicines have side effects that are important in dental care. Examples include dry mouth which may be caused or exacerbated by certain antidepressants, gingival hyperplasia linked to some drugs used for epilepsy, anti-hypertensives and immunosuppressant medications.

Drug interactions, e.g. some antibiotics and the oral contraceptive pill, are another feature which dentists need to be aware of when a new patient arrives or an existing patient has their medication regime changed by their GP or by a hospital department.

Drugs Used in Dentistry and/or May Impact on Dentistry

Drugs which may complicate dental procedures
A patient history of conditions and medications is important as certain drugs may complicated dental procedures.

Drugs that increase the risk of bleeding:
Anticoagulants: Indirect-acting anticoagulants (warfarin), direct acting anticoagulants e.g. apixaban. In 2020, 384,791 GMS prescriptions were written for apixaban alone.

Antiplatelets: Aspirin. (cardiovascular secondary protection in patients at risk of MI). Patients may not be aware of the bleeding risk associated with acetylsalicylic acid as the focus from the prescriber is very often GI side effects that may occur. They may not think it important to tell the dentist. In 2020, 1,896,792 prescriptions were written for acetylsalicylic acid. This does not take into account acetylsalicylic acid (aspirin) bought without prescription and may be being used chronically for pain and inflammation.

Drugs causing osteonecrosis of the jaw (ONJ)
Bisphosphonates e.g. zoledronic acid. Used mainly in the treatment of osteoporosis in post-menopausal women
Drugs used in the treatment of various cancers e.g. protein kinase inhibitors, monoclonal antibodies

Drugs which may contribute to deteriorating oral health
A patient history of medications may give clues as to why a patient is experiencing deteriorating oral health.

Inhaled corticosteroids: If the patient doesn’t rinse their mouth after each use, they may have repeated oral candidiasis
Drugs causing dry mouth. Some Proton Pump Inhibitors, SSRIs and SNRIs, anti-psychotics, anti-epileptics, ADHD medicines, some analgesics and those drugs with anticholinergic side effects e.g. antimuscarinic bronchodilators (glycopyrronium).

Antibiotics prescribed for children: Dose

IMF provides paediatric dosing information according to the license but also Irish-specific dosing guidelines based on both weight and age for more accurate dosing (HSE, ICGP, HPSC).

Antibiotics prescribing: Precautions

Specific information on drug interactions:
Amoxicillin/clavulanic acid and warfarin: Reported cases if increased INR in patients maintained warfarin; if co-admin is necessary, prothrombin time or INR should be monitored. This needs to be discussed with the patient. Awareness of this is important if follow-up dental work after the course of antibiotics is scheduled.

Amoxicillin/clavulanic acid and methotrexate: Penicillins may reduce the excretion of methotrexate causing a potential increase in toxicity. Methotrexate may be prescribed in the oncology setting but also rheumatoid arthritis.

Metronidazole and anticoagulants: Potentiation of the anticoagulant effect and increased haemorrhagic risk caused by decreased hepatic catabolism. In case of coadministration, prothrombin time should be more frequently monitored and anticoagulant therapy adjusted during treatment with metronidazole.

Specific information on use in Pregnancy:
Metronidazole: Metronidazole should only be used during pregnancy or lactation following careful evaluation and only if considered essential by the physician. Its effects on foetal organogenesis are not known. If used, high dosage regimens should be avoided. The drug crosses the placenta and is excreted in breast milk in which concentrations equal those in serum. Unnecessary exposure to the drug should be avoided.

IMF books provide dentists with key medicines information, that information is always available to the team even when IT problems cause chaos to the computer systems in the practice.

 
 
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