Guanethidine 1% / Adrenaline 0.2% eye drops

The widespread use of pharmaceutical agents highlights the importance of identifying potential pharmacological interactions with epinephrine, the most frequently used vasoconstrictor in dental practice. Dentists must be aware of possible risks in order to adjust anesthetic protocols, when necessary. The principal aim is to prevent complications and ensure patient safety. This review analyzes clinical data from the international literature on pharmacological interactions involving low-dose epinephrine, corresponding to the doses typically used in dental procedures. These interactions are subsequently classified according to their severity and documentation level, based on the criteria of the UpToDate Lexidrug platform. In addition, management strategies are proposed to guide dental practitioners in clinical decision-making. A literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library databases, using specific keywords. In total, 24 studies met the inclusion criteria, with the earliest published in 1968 and the most recent in 2022. Nine pharmacological categories were identified and presented in tables. The dosage of epinephrine plays a key role in the likelihood of pharmacological interactions, which appear to be less frequent at low concentrations typically used in dentistry. However, patient-specific factors, such as overall health status, should also be carefully considered during clinical assessment.

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The discovery of epinephrine (adrenaline) and its subsequent implications in medicine owes significant contributions to Cybulski across different centuries, who, in 1894, was pivotal in identifying the adrenal medulla’s role in blood pressure regulation and naming the active substance “nadnerczyna”, known today as adrenaline. His work demonstrated the adrenal glands’ critical function in the body’s regulatory mechanisms beyond the nervous system. Cybulski’s groundbreaking research laid foundational knowledge for future endocrinological studies and pharmaceutical advancements. In the late 20th century, Andruszkiewicz collaborated with Silverman at Northwestern University to develop pregabalin, the active ingredient in Lyrica. Their innovative synthesis of gamma-aminobutyric acid derivatives led to a significant advancement in treating epilepsy, neuropathic pain, and fibromyalgia. Andruszkiewicz’s expertise in organic chemistry and enzymology was crucial in this collaborative effort, resulting in the successful development and commercialization of Lyrica. Additionally, Mroczkowski’s leadership at Pfizer contributed to the development of crizotinib, a notable anaplastic lymphoma kinase and proto-oncogene 1 tyrosine-protein kinase inhibitor used to treat specific types of non-small cell lung cancer. Her work exemplifies the continuing influence of Polish researchers in pioneering drug discovery and advancing therapeutic treatments over the past three centuries. These contributions highlight Poland’s significant role in global pharmaceutical innovations and medical research.

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Abstract Stimulation of sympathetic nerves in the vas deferens yields biphasic contractions consisting of a rapid transient component resulting from activation of P2X1 receptors by ATP and a secondary sustained component mediated by activation of α 1 -adrenoceptors by noradrenaline. Noradrenaline can also potentiate the ATP-dependent contractions of the vas deferens, but the mechanisms underlying this effect are unclear. The purpose of the present study was to investigate the mechanisms underlying potentiation of transient contractions of the vas deferens induced by activation of α 1 -adrenoceptors. Contractions of the mouse vas deferens were induced by electric field stimulation (EFS). Delivery of brief (1s duration) pulses (4 Hz) yielded transient contractions that were inhibited tetrodotoxin (100 nM) and guanethidine (10 µM). α,β-meATP (10 µM), a P2X1R desensitising agent, reduced the amplitude of these responses by 65% and prazosin (100 nM), an α 1 -adrenoceptor antagonist, decreased mean contraction amplitude by 69%. Stimulation of α 1 -adrenoceptors with phenylephrine (3 µM) enhanced EFS and ATP-induced contractions and these effects were mimicked by the phorbol ester PDBu (1 µM), which activates PKC. The PKC inhibitor GF109203X (1 µM) prevented the stimulatory effects of PDBu on ATP-induced contractions of the vas deferens but only reduced the stimulatory effects of phenylephrine by 40%. PDBu increased the amplitude of ATP-induced currents recorded from freshly isolated vas deferens myocytes and HEK-293 cells expressing human P2X1Rs by 93%. This study indicates that: (1) potentiation of ATP-evoked contractions of the mouse vas deferens by α 1 -adrenoceptor activation were not fully blocked by the PKC inhibitor GF109203X and (2) that the stimulatory effect of PKC on ATP-induced contractions of the vas deferens is associated with enhanced P2X1R currents in vas deferens myocytes.

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