Mark Sebastian, DMD 33516 Ninth Ave. South, #2 Federal Way, WA 98003 (253) 941-6242 --or -- (253) 952-2005 fwperio@aol.com www.fwperio.com Lor az epam (Ativan®) instruc tion s If prescribed, take the diazepam (Valium®) pill just before bed the night before your dental surgery for a better night’s sleep. If you take other sleeping medications, take those instead of the diazepam (Valium®). Do not mix the two. If you have a morning appointment, you should to fast from solid foods after midnight. If you have an afternoon appointment, have a light breakfast. Unless you have a medical reason to eat (diabetic, etc.), do not eat anything for 6 hours before your appointment time. Water, apple juice, and black decaffeinated coffee/tea are OK for 3 hours before your appointment. Lorazepam (Ativan®) is absorbed better on an empty stomach. Do not take caffeine or sugar) for 3 hours before your appointment, as all are stimulants that decrease the effectiveness of triazolam (Halcion®). No tobacco use for 8 hours before, as it is a stimulant. Take the lorazepam (Ativan®) or diazepam (Valium®) pill(s) with a glass of water. Sparkling water makes them absorb better. Alcohol---do not drink within 24 hours before to 24 hours after taking lorazepam (Ativan®) or diazepam (Valium®). Recreational/illegal drugs---Do not use for 7 days before your dental surgery and until 7 days after (never if you are taking narcotic pain medication). Example—using cocaine and then having local anesthetics (novocaine) can kill you. Do not take lorazepam (Ativan®) or diazepam (Valium®) if you are allergic to triazolam (Halcion®), alprazolam (Xanax®), chlordiazepoxide (Librium®, Librax®), clonazepam (Klonopin®), clorazepate (Tranxene®), diazepam (Valium®), estazolam (ProSom®), flurazepam (Dalmane®), lorazepam (Ativan®), oxazepam (Serax®), prazepam (Centrax®), temazepam (Restoril®). Do not take lorazepam (Ativan®) or diazepam (Valium®) or use nitrous oxide (laughing gas)if you are, or think you might be, pregnant. If you are a nursing mother, discard your milk for 3 days after taking lorazepam (Ativan®) and 1 week for diazepam (Valium®). Nitrous oxide (laughing gas) alone should not affect breast milk). Do not take lorazepam (Ativan®)or diazepam (Valium®) if you have acute narrow-angle glaucoma. Lorazepam (Ativan®) can dry your eyes out. Don’t wear contact lenses to your appointment.
Antacids (such as Maalox®, Mylanta®, Tums®), reduces the absorption and effectiveness of lorazepam (Ativan®) or diazepam (Valium®) if taken within 3 hours of taking lorazepam (Ativan®) or diazepam (Valium®). Heartburn/ulcer medications: Tagamet® (cimetidine), Pepcid® (famotidine), Zantac® (ranitidine), Prilosec® (omeprazole, and Nexium® (esomeprazole) should not be taken within 24 hours before to 24 hours after taking diazepam (Valium®). They increase the potency of diazepam (Valium®). They do not affect lorazepam (Ativan®). Narcotic pain medications (such as codeine, Vicodin®, Percodan®, Demerol®, and others) should not be taken within 12 hours before to 12 hours after taking lorazepam (Ativan®) or diazepam (Valium®). Post-opertively, do not take any narcotic pain medication until 12 hours after you take the lorazepam (Ativan®). 1000mg Tylenol® (acetaminophen) and 600 mg ibuprofen taken together (maximum of once every 6 hours) is an excellent replacement/substitute for a narcotic. If you can’t take ibuprofen, let us know so we can get you another medication you can take that lorazepam (Ativan®) will not interfere with. Nutritional supplements: St. John’s Wort, Kava Kava, Gotu Kola and Valerian may greatly decrease the longevity of the sedation effects of diazepam (Valium®), while potentially greatly increasing the profoundness of the sedation. Do not take these herbs for 10 days before taking lorazepam (Ativan®) or diazepam (Valium®). You can resume them 3 days afterward. Do not take diazepam (Valium®) if you are taking the following medications: Diltiazem (Cardizem®, Dilacor®, Tiazac®, Tiamate®, Cartia®, and others) used for Verapamil (Calan®, Verelan®, Covera®, Isoptin®, Tarka®) used for high blood Ketoconazole (Nizoral®) used for yeast/fungal infections Itraconazole (Sporanox®) used yeast/fungal infections Nefazodone (Serzone®) used as an anti-depressant Ritonavir (Norvir®) used for HIV/AIDS Atazanavir (Reyataz®) used for HIV/AIDS Cyclosporine, (Sandimmune®, Neoral®) used for organ transplant rejection Diltiazem (Cardizem®, Dilacor®, Tiazac® and others) high blood pressure and angina Imatinib (Glivec®) used to treat leukemia Izoniazid (Nydrazid®) used to treat TBNicardipine (Cardene ®) used to treat high blood pressure Quinidine (Quinora®, Quinidex®, Cardioquin®) used to treat abnormal heart rhythms Clozapine (Clozaril®, FazaClo®) used to treat schizophrenia Erythromycin (many brands including E-mycin®), EES®, PCE®) used as an antibiotic Clarithromycin (Biaxin®) used as an antibiotic Telithromycin (Ketek®) used as an antibiotic Diclofenac (Voltaren®), used as prescription eye drops or pills for arthritis or cramps. Do not take lorazepam (Ativan®) if you are taking the following medications:
Clozapine (Clozaril®, FazaClo®) used to treat schizophrenia Nefazodone (Serzone®) used as an anti-depressant Loxapine (Loxapac ®, Loxitane®) used to treat schizophrenia Valproic acid (Depakote®) used to treat seizures Probenecid (Benuryl®) used to treat gout
The following medications can decrease the effects of sedation from lorazepam (Ativan®) or diazepam (Valium®). That does not mean discontinue these medications, just be aware that the sedation may not be profound.
Aminoglutethimide (Cytadren®) used to treat Cushing’s syndrome
Carbamazepine (Carbatrol®, Tegretol®) used to treat seizures, bipolar,
Nafcillin (Unipen®) a specific antibiotic
Nevirapine (Viramune®) used to treat HIV/AIDS Phenobarbital used to control epileptic seizures Phenytion (Dilantin®) used to control epileptic seizures Rifamycins a class of antibiotics used to treat TB Theophylline (TheoDur®, Theolair®, and others) used to treat asthma, emphysema, chronic bronchitis Yohimbine (Procomil®) in Rx and OTC for treating depression and erectile dysfunction
Do not eat grapefruit or drink grapefruit juice while taking diazepam (Valium®). Grapefruit increases the amount of the drug absorbed and the amount of time it stays in the body, thus having the potential to way over sedate you. Therefore, people taking diazepam (Valium®) should totally avoid grapefruit and grapefruit juice starting 3 days before taking these medications and wait until the day after your appointment to consume them again. Even one small glass or a half grapefruit will have this effect and take 3 days to clear your body The following drugs have the same effect as grapefruit., but they increase the potency and duration of both lorazepam (Ativan®) or diazepam (Valium®). Let us know if you are taking these, as we may reduce the amount of lorazepam (Ativan®) and/or diazepam (Valium®):
Antidepressants, such as but not limited to Sertraline (Zoloft®),Paroxetine (Paxil®),
Amitriptyline (Elavil®), Clomipramine (Anafranil®), Isocarboxazid (Marplan), Phenelzine (Nardil®), Tranylcypromine (Parnate®), Flouxetine (Prozac®), Bupropion (Wellbutrin®)
Ergotamine (Cafergot®) used migraines (effected by diazepam, but not lorazepam)
Fluvoxamine (Luvox®) used for obsessive-compulsive disorder
Alprazolam (Xanax®) or BuSpar used for anxiety
Arrange for a ride to and from your dental appointment. Your ride does not need to stay the entire appointment. They can come back at a certain time, and leave a telephone number in case we finish early or run late. We will ask your driver to sign that we are releasing you into their care and they will drive, not you. Do not drive a motor vehicle after taking from lorazepam (Ativan®) or diazepam (Valium®). Do not drive for the rest of the day or the next day after taking the from lorazepam (Ativan®) or diazepam (Valium®) pill(s). It is illegal to drive a motor vehicle under the influence of any mind-altering substance, including legal medications. That also includes narcotics, such as codeine, Vicodin® (hydrocodone), Demerol® (meperidine) and Percodan®/Percocet®/Roxicet® (oxycodone). Ibuprofen, Tylenol® and antibiotics are not mind-altering.
Go to the restroom as soon as you get here. It saves interrupting your surgery for a “groggy” trip to the restroom. After you get home from your oral surgery, rest and drink plenty of water, at least 6 glasses the rest of the day. If you get up in the middle of the night, have another glass of water. Water consumption eliminates a “hangover” the next day. If you take plenty of water after you get home, no hangover and you will feel fine the next day. Arrange for someone to stay with you the rest of the day after you get home. You may feel fine, but from lorazepam (Ativan®)can be an amnesic for some people for up to 8 hours later. That means you may do stuff you don’t remember. That’s not safe if you are alone, or if you try to drive a car, cut the grass, etc. Do not plan on signing any legal papers or drive a motor vehicle for 48 hours after you take from lorazepam (Ativan®) or diazepam (Valium®), or for as long as you are taking narcotic pain medications.
Do not go up and down stairs for the rest of the surgery day without an adult helping you and they are one step below you. It is best to avoid stairs for the day. Follow your post-op instructions for rest in a recliner chair, ice the surgical area and have something of nutritious value, like Ensure, Carnation Instant Breakfast, Boost, Glucerna for diabetics, etc. as soon as you arrive home. ***We will discuss your procedure and follow-up instructions and care with your driver, escort/companion, spouse or caregiver because you may not remember what we told you.
Recipe for Lomitos de Carne, Rellenos (Stuffed Beef) Have your butcher cut very thin strips of raw beef with the grain: 3 inches wide, 5 or 6 inches long; tenderloin, sirloin, top round, will all do well. Make marinade of 1 part each lime or lemon juice, 1 part orange juice, 3 parts olive oil, ½ part chopped onion. Season with plenty of fresh-made Garlic Salt (see recipe below), Tabas