Triazolam and Phenergan are medications that will relax you, and minimize anxiety that
may be associated with Periodontal Treatment. In a relaxed and comfortable state, you
will still be awake and able to communicate with your Periodontist and/or Hygienist
while the treatment is being performed. Even though these medications are safe, and
wear off rapidly after the appointment, you should be aware of some important
precautions:
1. This form should be signed before you take the medication(s).
2. The onset of the medication(s) is 15 to 30 minutes. DO NOT DRIVE OR OPERATE MACHINERY AFTER YOU HAVE TAKEN THE MEDICAITON(S). The
peak effect occurs between 1 and 2 hours. For safety reasons, and because people react
differently, you should not drive or operate machinery the remainder of the day.
3. The medication(s) should NOT be used if
- You are hypersensitive to benzodiazepines (Valium, Ativan, Verse, Etc.).
- You are pregnant or breast feeding.
- You have liver or kidney disease.
Tell the doctor if you are taking the following medications as they can adversely interact
with Triazolam: nefazodone (Serzone); cimetidine (Tagmet, Tagamet HB,
Novocimetine, or Peptol); levodopa (Dopar or Larodopa) for Parkinson’s Disease;
antihistamines (suc as Benadryl and Tavist); verapamil (Calan); diltiazem (Cardizem);
erythromycin and the azole antimycotics (Nizoral, Biaxin, or Sporanox); HIV drugs
(Indinavir and Nelfinovir); and alcohol. Of course, taking recreational/illicit drugs can
also cause untoward reactions.
4. Side effects with oral sedatives may include light-headedness, headache,
dizziness, visual disturbances, amnesia and nausea. In some people, oral
Triazolam may not work as desired.
5. Smokers will probably notice a decrease in the medication(s) ability to achieve
desired results.
6. Do Not eat heavily prior to your appointment. You may take the medication(s)
with a small amount of food, such as juice, toast, etc. Taking it with too much
food can make absorption into your stomach unpredictable.
7. On the way home from the appointment, your seat in the car should be in the
reclined position. When at home, lie down with your head slightly elevated.
Someone should stay with you for the next several hours because of possible
disorientation and possible injury from falling.
I understand that under no circumstances am I to drive while taking these medications. I also
understand that I am to provide a responsible driver to transport me to and from my
appointment. I understand these conditions, and I am willing to abide by the conditions
stated above. I have had an opportunity to ask questions and have them answered to my satisfaction