I am a little scared

[metekrop]

Hi there,

How are you guys doing?  My doctor told me that I have to take out my teeth some time ago.  However, since I haven't had any pain, I did not wanted to take it out because of the meds (Atripla) I am on.  Now I am tinkling of taking it off.  So do you guys  know if there might be any problem with the Anastasia I'm going to be given when they took my teeth out.  I am a little scared?  TX

[pittman]

 That is the type of question best asked directly to your HIV doctor.

That being said, I have not heard of anything that would lead me to suspect such a problem with Atripla.

[metekrop]

Pittman,

Thank you for your input!

[leatherman]

some types of anesthesia are not recommended with Atripla
Truvada+sustiva and general anesthesia

I think you have some of the same components of Atripla.  Hubby carries a card that says nothing in the class  Benzodiazapines which includes Versed ( generic  Midazolam).  After  things going bad during his colonoscopy and another round from surgery 2 or 3 , the anesthesiologist got together with the pharmacist and he came back with this written out  from the atripla label.  It is best to have your anesthesiologist get together with pharmacy and check.  Too many anesthesiologists are not familiar with HIV meds.  He had general anesthesia  3 more times where different meds were used with no problems and one where they kept him awake  and did an alternate shortened version of the surgery to prevent having a problem.  One anesthesiologist gave him Midazolam  even after the warning and filled him full of  heart meds and steroids to counter the  reaction.  From the Sustiva Label:
Contraindicated Drugs

For some drugs, competition for CYP3A by efavirenz could result in inhibition of their metabolism and create the potential for serious and/or life-threatening adverse reactions (eg, cardiac arrhythmias, prolonged sedation, or respiratory depression). Drugs that are contraindicated with SUSTIVA are listed in Table 2.

Table 2: Drugs That Are Contraindicated or Not Recommended for Use With SUSTIVA
Drug Class: Drug Name    Clinical Comment
Antimigraine: ergot derivatives (dihydroergotamine, ergonovine, ergotamine, methylergonovine)    Potential for serious and/or life-threatening reactions such as acute ergot toxicity characterized by peripheral vasospasm and ischemia of the extremities and other tissues.
Benzodiazepines: midazolam, triazolam    Potential for serious and/or life-threatening reactions such as prolonged or increased sedation or respiratory depression.
Calcium channel blocker: bepridil    Potential for serious and/or life-threatening reactions such as cardiac arrhythmias.
GI motility agent: cisapride    Potential for serious and/or life-threatening reactions such as cardiac arrhythmias.
Neuroleptic: pimozide    Potential for serious and/or life-threatening reactions such as cardiac arrhythmias.
St. John's wort (Hypericum perforatum)    May lead to loss of virologic response and possible resistance to efavirenz or to the class of non-nucleoside reverse transcriptase inhibitors (NNRTI).

You should speak to your hiv doctor about this as there are some drugs used in general anesthesia which are contraindicated for use with Sustiva.

I found some information here. It's a little out of date but you may be able to find more information by googling "general anesthesia" + efavirens, "general anesthesia" + tenofovir and "general anesthesia" + emtricitabine. I find it's usually better to search using the generic names of the drugs rather than the brand names. You get more scholarly information that way.

From the link above:

Midazolam (Versed) is a drug commonly used for general anesthesia in outpatient surgery and other routine medical procedures where the patient must be "knocked out." If you are taking any of the following anti-HIV drugs, be sure to remind your doctor, nurse, etc. These drugs have interactions with midazolam that can put you into a coma! The reason this happens is competition between the anti-HIV drugs and midazolam, causing the midazolam to build up in the body. The result is like getting an overdose of midazolam. Although your health care provider should always check for drug interactions, it never hurts to remind him or her. Another anesthetic agent can be substituted for the midazolam.

    * Amprenavir (Agenerase)

    * Delavirdine (Rescriptor)

    * Efavirenz (Sustiva)

    * Indinavir (Crixivan)

    * Lopinavir/ritonavir (Kaletra)

    * Nelfinavir (Viracept)

    * Ritonavir (Norvir)

    * Saquinavir (Fortovase or Invirase)

You should definitely talk to your hiv doc about this before your surgery. He/she should be able to tell you what meds are ok and maybe even get in touch with your surgeon for you. Good luck with the op!

[MitchMiller]

I'm curious why your dentist wanted to remove teeth if they aren't causing a problem? 

Before I begin, full disclosure: I rank dentists and doctors right along side used car salesmen. 

I'm 57 and still have all my wisdom teeth.  Three out of five dentists I've seen are always telling me I need to have those out to be "proactive" in preventing gum disease.  They've been telling me that for 27 years now!   Before I relocated from NYC, my dentist in NYC warned me to NEVER let a dentist pull those teeth unless there was a REAL problem.  He warned me dentists would all be trying to do so.  My cousin is a dentist who also told me pulling wisdom teeth is a de-facto "revenue generator." 

The first dentist that tried to remove them saw I was in disbelief so she sent me to her friend for a second opinion.   They must have been having a lesbian spat because her friend contradicted the diagnosis and told me to use a Butler brush around my molars and I would have no gum disease.  Best advice I ever got.

Not sure what your situation is.  I have other stories about "bad" dentists so be careful.

[Miss Philicia]

I have all of my wisdom teeth and I've never had any of the numerous dentists in my life suggest yanking them. I guess they weren't used car salesmen.

[pittman]

Maybe they thought the wisdom needed to sink in some more before removing them Miss P.? 

Mine were pulled in my 20’s. Perhaps too soon.

I was guessing the OP meant more than their wisdom teeth of course.

[tednlou2]

Ah, the wisdom teeth issue.  When I was 18, my dentist insisted I should have all mine surgically removed, even though I had no issues.  He insisted and insisted.  I figured he knew what was best.  The oral surgical doc was his business partner.  The surgery pain was bad and I only got 7 pain pills.  When I returned about the pain and one side of my tongue being numb, I was accused of being a pain pill seeker.  Seven pain pills turned me into a drug seeker...lol.  I think he was dodging the fact a nerve was damaged.  One side of my tongue was numb for years.  It either went away, or I just got use to it. 

What's my point?  I do think some push the surgery for financial reasons.  I do think it was pushed on me, like a car salesman would push (insert whatever here).  Having said that, it is possible they would have caused me problems at some time; I obviously will never know.  However, I could have dealt with them at that point and before they got bad or anything.