Nonselective b-blockers can have a drug interaction with epinephrine,causing a two- to fourfold increase in vasopressor response.A gingival retraction cord containing epinephrine may be used,however.

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In patients with cardiovascular disease or higher blood pressure,the amount of epinephrine given to patients taking nonspecific b-blockers should be limited to the cardiac dose unless careful blood-pressure monitoring accompanies the use of larger doses.Neither gingival retraction cord containing epinephrine nor 1:50,000 epinephrine should be used.The amount of caution required with this drug interaction depends on the patient's underlying cardiovascular disease,if any increase in blood pressure,and the dose of the b-blocker the patient is taking.The dentist should avoid using gingival retraction cord that contains epinephrine because these cords contain epinephrine that is highly concentrated.It can be quickly absorbed into sulcular tissue and lead to tachycardia and elevated blood pressure.

Nonselective B-Blockers Can Have a Drug Interaction with Epinephrine,causing a Two-