Ephedrine hydrochloride

Description
An adrenoceptor stimulant.
Indications
Used in the treatment of reversible airway obstruction and the management of nasal congestion.
Effects on oral and dental structures
May produce xerostomia.
Effects on patient management
Patients may not be comfortable in the supine position if they have respiratory problems. If the patient is suffering from asthma then aspirin-like compounds should not be prescribed as many asthmatic patients are allergic to these analgesics. Similarly, sulphite-containing compounds (such as preservatives in epinephrine-containing local anaesthetics) can produce allergy in asthmatic patients. Xerostomia may increase caries incidence and thus a preventive regimen is important. If the xerostomia is severe artificial saliva may be indicated.
The use of a rubber dam in patients with obstructive airway disease may further embarrass the airway. If a rubber dam is essential then supplemental oxygen via a nasal cannula may be required.
Drug interactions
The adrenergic effects of epinephrine in dental local anaesthetics will be enhanced by ephedrine, so dose reduction should be considered.
A hypertensive crisis can occur with concurrent use of monoamine oxidase inhibitors. Ephedrine increases the metabolism of dexamethasone.
There is an increased chance of dysrhythmia with halogenated general anaesthetic agents.