ORAL SEDATION AND CONSENT FORM
Taking an oral sedative-hypnotic (Ativan or Halcion) prior to your dental appointment is an excellent way to minimize or eliminate anxiety that may be associated with going to the dentist. Even though it is safe, effective and tends to wear off rapidly after the dental visit, you should be aware of some important precautions and considerations.
HOWEVER, YOU MUST TAKE THESE SEDATIVES EXACTLY AS PRESCRIBED!
1. This consent form and the dental treatment consent form should be signed before you take the medication.
2. The onset of Halcion is 15-30 minutes, while for Ativan it's 30-45 minutes. Do not drive after you have taken the medication. The peak effect for these drugs occurs between 1-2 hours. After that, it starts wearing off and most people feel back to normal after 6-12 hours. For safety reasons and because people react differently to the same drug, you should not drive or operative machinery for the remainder of the day. Lingering effects have been reported up to 24 hours.
3. This medication should not be used if:
- Have a history of hypersensitivity to Benzodiazepines (Valium, Ativan, etc) You are pregnant (or considering becoming pregnant) or breast feeding - You have a liver or kidney disease - You are taking other medications and have not cleared them with your administering doctor. Ativan and Halcion may produce increased CNS-depressant effects when administred with other CNS depressants such as alcohol, barbiturates, antipsychotics, sedative/hypnotics, anxiolytics, antidepressants, narcotic analgesics, sedative antihistamines, anticonvulsants, and anesthetics. Such medications are: Nefazodone antidepressant (Serzone); Cimetidine (Tagamet, Tagamet HB, Novocimetine, Peptol); Levodopa (Dopar or Larodopa) for Parkinson's disease. The following medications may prolong the effect of Halcion: Benedryl, Phenergan, Verapamil (Calan), Cardizem (Diltiazem), Erythromycin, HIV drugs Indinavir & nelfinovir, and Alcohol. There may be unusual and dangerous reactions if you are currently taking illegal drugs. - A Sleep apnea disorder should also be reported.
4. Side effects may include: light-headedness, headache, dizziness, visual disturbances, amnesia and nausea. In some people oral sedation may not work as desired. 5.Smokers will probably notice a decrease in the medications ability to achieve desired results.
6. You should not eat heavily prior to your appointment. You may take the medication with a small amount of food such as juice, toast, etc. Taking it with too much food can make absorption into your system unpredictable.
7. On the way home from the dentist, your seat in the car should be in a slightly reclined position. When at home, lie down with the head slightly elevated. An adult should stay with you for the next several hours because of possible disorientation and possible injury from falling. In addition, Halcion has been associated with lingering amnesia for several hours after its intake, leading to actions where the patient does not remember them, e.g. turning on the stove, or driving.
8.I understand these considerations and I am willing to abide by the conditions stated above. I have had the opportunity to ask questions and have had them answered to my satisfaction.
9.I hereby state that I read, speak, and understand English.