• For patients taking oral biphosphonates, the two factors that significantly increase the risk of developing osteonecrosis of the jaws are, the duration of continuous oral biphosphonate therapy: treatment of 3 years or more is associated with progressively increased risk, and concomitant use of steroids, particularly prednisone. (blumnico.com)
  • The bisphosphonate related osteonecrosis of the jaws (BRONJ) is defined as a drug-adverse reaction that involves the maxillary bones. (peertechzpublications.com)
  • The clinical pattern was described for the first time by Marx RE in 2003, who observed the development of jaws osteonecrosis in patients underwent to Multiple Myeloma and Mammary Cancer therapy [2]. (peertechzpublications.com)
  • Summary: The administration of teriparatide (TPTD) in conjunction with periodontal care could provide faster and more favorable clinical outcomes in previously refractory bisphosphonate-related osteonecrosis of the jaws (BRONJ) cases compared to conventional dental care, combination of surgery and antimicrobial treatment. (elsevierpure.com)
  • We selected the following preferred terms: osteonecrosis of the jaws, osteonecrosis, osteomyelitis. (bmj.com)
  • The jaws are particularly sensitive to osteonecrosis due to high bone turnover resulting from daily activity and the presence of teeth 1 . (medsafe.govt.nz)
  • Patients may be considered to have bisphosphonaterelated ONJ if they have current or previous treatment with a bisphosphonate and have exposed or necrotic bone in the maxillofacial region that has persisted for more than eight weeks with no history of radiation therapy to the jaws 2 . (medsafe.govt.nz)
  • Medication-related osteonecrosis of the jaw (MRONJ) is an adverse drug reaction, described as an exposed necrotic bone or a bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region, that persists for more than 8 weeks in patients without a history of radiotherapy or disease metastasis to the jaws ( 1 , 2 ). (frontiersin.org)
  • Results from a three year study of Oral Bisphosphonates related osteonecrosis of the jaws: Implications for more accurate diagnosis etiology/pathogenesis. (creighton.edu)
  • Necrotic jaws or other maxillofacial skeleton necrosis associated with bisphosphonate use (see BISPHOSPHONATES). (childrensmercy.org)
  • The clinical patterns of adverse drug reactions of the oral cavity include xerostomia, swelling, nonspecific ulceration, vesiculobullous or ulcerative mucositis that mimics other disease states, nonspecific vesiculoulcerative mucositis, pigmentation, gingival enlargement, and medication-related osteonecrosis of the jaws. (medscape.com)
  • Medication-related osteonecrosis of the jaw (MRONJ) is a rare and potentially debilitating condition that involves exposure of the bone of the jaws. (merckmanuals.com)
  • Prediction of medication-related osteonecrosis of the jaws using machine learning methods from estrogen receptor 1 polymorphisms and clinical information. (cdc.gov)
  • Evidence is insufficient to confirm a causal link between low-dose bisphosphonate use in osteoporosis with osteonecrosis of the jaw. (medscape.com)
  • The bisphosphonates (BFs) are synthetic drugs used to treat multiple myeloma, bone pathologies associated with malignancy, Paget's disease and osteoporosis. (bvsalud.org)
  • Because of occurring osteoporosis, the patient underwent to bisphosphonates administration. (peertechzpublications.com)
  • Even though laboratory normal ranges are said to be between 50 pg/mL and 450 pg/mL, this normal range is not accurate related to the osteoporosis population. (wikipedia.org)
  • We investigated awareness in dental hygienists of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients with osteoporosis and cancer and assessed the situation in systemic history investigations to broaden the scope of the dental hygienists ' BRONJ awareness as a basis for contributing to preventing this disease . (bvsalud.org)
  • We present a case of non-surgically managed bilateral osteonecrosis of the external auditory canal with a history of long-term medical therapy for osteoporosis. (bmj.com)
  • Osteoporosis is increasing in prevalence alongside an ageing population and oral bisphosphonates are the recommended first-line antiresorptive therapy. (bmj.com)
  • You can't restore your bone density to what it was at its peak, but you can stimulate bone formation and slow age-related bone loss by engaging in weight-bearing and muscle-building exercises, following a healthy diet, and taking one of the drugs approved for the treatment of osteoporosis. (everydayhealth.com)
  • Bisphosphonates and denosumab are medications that limit the loss of bone density in people with conditions such as osteoporosis and bone cancer. (merckmanuals.com)
  • The risk of MRONJ in people who have osteoporosis and are taking bisphosphonates by mouth is extremely low. (merckmanuals.com)
  • METHODOLOGY: Veterans with a SCI/D with at least one prescription for an osteoporosis medication (bisphosphonate, calcitonin, denosumab, raloxifene, and teriparatide) who received healthcare within Veterans Affairs (VA) from 2005 to 2015 were identified using VA administrative databases. (va.gov)
  • Bisphosphonates were the most frequently prescribed medication for osteoporosis (n? (va.gov)
  • The 2014 update of a position paper from the American Association of Oral and Maxillofacial Surgeons (AAOMS) recommended changing the name of bisphosphonate-related osteonecrosis of the jaw (BRONJ) to medication-related osteonecrosis of the jaw (MRONJ), owing to the increased number of maxillary and mandibular osteonecrosis cases that have been linked to other antiresorptive (denosumab) or antiangiogenic treatments. (medscape.com)
  • In addition, bisphosphonates, denosumab, and other bone-modifying agents showed a significantly higher risk of developing MRONJ owing to the changes in salivary microbiome profiles, cytokine profiles, interleukins, hypotaurine, and binding proteins. (frontiersin.org)
  • 10 years of once weekly bisphosphonate therapy before switching to denosumab. (bmj.com)
  • We report the first case of bilateral osteonecrosis of the external auditory canal associated with denosumab and bisphosphonates with successful conservative management. (bmj.com)
  • Yarom N, Lazarovici TS, Whitefield S, Weissman T, Wasserzug O, Yahalom R. Rapid onset of osteonecrosis of the jaw in patients switching from bisphosphonates to denosumab. (unicamp.br)
  • MRONJ occurs in some people who have taken or are taking high doses of bisphosphonate medications intravenously or the drug denosumab , particularly if they have cancer or undergo oral surgery. (merckmanuals.com)
  • People who do not have cancer or who have not taken bisphosphonates or denosumab can develop osteonecrosis of the jaw, but it is extremely rare. (merckmanuals.com)
  • The unique predisposition for bony necrosis in the jaw may be related to the microenvironment in the maxilla and mandible secondary to compromised vascular supply and presence of oral microflora that may super-infect a poorly healing wound in the jaw bone. (drug-injury.com)
  • Avascular necrosis (AVN) is also known as osteonecrosis, aseptic necrosis, and ischemic necrosis. (cadth.ca)
  • Osteonecrosis = aseptic necrosis, avascular necrosis, ischemic necrosis and osteochondritis dessicans. (slideserve.com)
  • Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a condition found in patients who have received intravenous and oral forms of bisphosphonate therapy for various bone-related conditions. (medscape.com)
  • Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is thought to be caused by trauma to dentoalveolar structures that have a limited capacity for bone healing due to the effects of bisphosphonate therapy. (medscape.com)
  • Several studies of patients with multiple myeloma and patients with breast cancer who received intravenous aminobisphosphonate therapy for metastatic bone lesions demonstrated 6-11% of the patients developed bisphosphonate-related osteonecrosis of the jaw (BRONJ). (medscape.com)
  • It develops during or after a long-term bisphosphonate therapy in absence of radiotherapy [1]. (peertechzpublications.com)
  • The strong inhibition of osteoclast function precipitated by bisphosphonate therapy can lead to inhibition of normal bone turnover, leading to impaired wound healing following trauma (such as dental surgery) or even spontaneous non-healing bone exposure. (wikipedia.org)
  • Patients administered with bisphosphonates, steroids, chemotherapy, thalidomide, interferon, and hormone therapy had a significantly higher association between decreased salivary flow and MRONJ occurrence. (frontiersin.org)
  • Aim: This study aimed to systematically review existing literature regarding the association between dental procedures-such as tooth extractions and periodontal therapy-and occurrence of medication-related osteonecrosis of the jaw (MRONJ) in individuals using bone-modifying drugs. (unicamp.br)
  • Mishra MB, Mishra S, Mishra R. Dental care in the patients with bisphosphonates therapy. (unicamp.br)
  • Osteonecrosis of the mandible associated with bevacizumab therapy. (unicamp.br)
  • Bisphosphonate related osteonecrosis of the jaw (BRONJ) is a recently described adverse side effect of bisphosphonate therapy, with an estimated 94% of cases reported in the oncologic patients receiving intravenous nitrogen-containing bisphosphonates (BP). (ca.gov)
  • Oral infection is considered to play a critical role in the pathogenesis of bisphosphonate-related osteonecrosis of the jaw (BRONJ), and antibiotic therapy has become a mainstay of BRONJ therapy. (nih.gov)
  • Poor gastrointestinal absorption, potential gastrointestinal and musculoskeletal adverse effects, irregular dosing regimens, and patient fear of rare but serious complications of therapy such as atypical femoral fracture and osteonecrosis of the jaw-all have a potential negative impact on patient adherence to therapy. (ccjm.org)
  • Medication-related osteonecrosis of the jaw (MRONJ) is a clinical risk for patients on bisphosphonate therapy. (medicalindependent.ie)
  • The risk of MRONJ remains, even years after active bisphosphonate therapy. (medicalindependent.ie)
  • A systemic contraindication systemic bisphosphonate therapy for malignancy. (medscape.com)
  • Osteonecrosis of the jaw Complications after a dental procedure that include swelling and pain, dry socket, osteomyelitis, bleeding, and osteonecrosis of the jaw comprise another set of urgent dental problems that require. (merckmanuals.com)
  • MRONJ may be a refractory osteomyelitis rather than true osteonecrosis, particularly when developing after bisphosphonate use. (msdmanuals.com)
  • As for the ONJ risk factors, Dr. Bilezikian states: 'Predisposing factors for the development of osteonecrosis of the jaw appear to be dental disease, dental surgery (e.g., tooth extraction), oral trauma, periodontitis, and poor dental hygiene. (drug-injury.com)
  • Bisphosphonate-related osteonecrosis of the jaw (BRONJ) manifests as exposed, nonvital bone involving the maxillofacial structures. (medscape.com)
  • In patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ), panoramic and plain radiography of the mandible reveal areas of sclerosis, destruction, sequestration, or pathologic fractures. (medscape.com)
  • Computed tomography (CT) scanning and magnetic resonance imaging (MRI) may also be beneficial in the assessment of bisphosphonate-related osteonecrosis of the jaw (BRONJ). (medscape.com)
  • Surgical intervention for bisphosphonate-related osteonecrosis of the jaw (BRONJ) remains limited because of the impaired ability of the bone to heal. (medscape.com)
  • Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is relatively new to the medical and dental literature. (medscape.com)
  • The true incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) has yet to be determined. (medscape.com)
  • The incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) has been strongly correlated with the aminobisphosphonates pamidronate (Aredia) and zoledronic acid (Zometa) and is even higher in patients who have had recent dental extractions. (medscape.com)
  • Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a condition in which bones of the maxillofacial skeleton, in particular the tooth-bearing areas, become necrotic and exposed to the oral cavity. (medscape.com)
  • Bisphosphonate-related osteonecrosis of the jaw (BRONJ) can be spontaneous, commonly appearing in the mylohyoid ridge area. (medscape.com)
  • Bisphosphonate-related osteonecrosis of the jaw (BRONJ) may also be caused by trauma, such as a tooth extraction or dental surgery. (medscape.com)
  • [ 7 , 8 ] Injury to the bone in these patients via tooth extraction, dental surgery, or mechanical trauma is thought to initiate bisphosphonate-related osteonecrosis of the jaw (BRONJ). (medscape.com)
  • Background Bisphosphonate-related osteonecrosis of the jaw (BRONJ) adverse drug reactions (ADRs) have been increasing since 2002. (bmj.com)
  • percentage of BRONJ associated with BP-related ADRs (103 out of 157, equal to 65.6% in 2006, and 61 out of 182 equal to 33.5% in 2012). (bmj.com)
  • Does vascularized bone reconstruction provide optimum reconstruction among patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ)? (enttoday.org)
  • There is no widely accepted gold standard for the treatments of bisphosphonate-related osteonecrosis (BRONJ). (thepmfajournal.com)
  • 2-4 An increased risk of developing osteonecrosis is associated with intravenous administration or when treatment is sustained over 3-5 years. (bmj.com)
  • Despite the wide availability of bisphosphonate drugs that reduce fracture risk, treatment rates have fallen, attributable to concerns for atypical femoral fractures and osteonecrosis of the jaw. (kaiserpermanente.org)
  • The AAOMS's 2022 update to its position paper on medication-related osteonecrosis of the jaw (MRONJ) lists medication families that have been implicated as risk factors for the condition since the 2014 update. (medscape.com)
  • This systematic review was performed to assess the potential influence of medication-induced salivary changes on the development of medication-related osteonecrosis of the jaw (MRONJ). (frontiersin.org)
  • In this presentation, Dr Byrne illustrated a case of MRONJ, following administration of bisphosphonates for metastatic breast cancer. (medicalindependent.ie)
  • This results in another cohort of patients exposed to bisphosphonates and at risk of MRONJ. (medicalindependent.ie)
  • To help prevent MRONJ, any necessary oral surgery should be done whenever possible before a person takes bisphosphonates. (merckmanuals.com)
  • therefore, when related to medications, ONJ is called MRONJ. (merckmanuals.com)
  • Most people with MRONJ have had cancer treated with high doses of bisphosphonates by vein. (merckmanuals.com)
  • Medication-related osteonecrosis of the jaw (MRONJ), formerly called bisphosphonate-related osteonecrosis of the jaw (BPONJ), is a rare and potentially debilitating condition. (msdmanuals.com)
  • Very rarely, osteonecrosis of the jaw (ONJ) with the same clinical manifestations as MRONJ occurs in patients who have not been treated with bisphosphonates or antiresorptive or antiangiogenic agents. (msdmanuals.com)
  • As potent inhibitors of osteoclast activity, the nitrogen-containing bisphosphonates might retard skeletal repair processes associated with trauma to or infection of the oral mucosa that involves the underlying bone. (drug-injury.com)
  • Other potential mechanisms include the possible antiangiogenic effects of nitrogen-containing bisphosphonates and the effects of these agents on T-cell function. (drug-injury.com)
  • None of the patients reported any history of head and neck radiotherapy or taking bisphosphonate or other antiresorptive or antiangiogenic medications. (drbicuspid.com)
  • The average cumulative minimum dose prior to diagnosis was 49mg for zoledronic acid, 2,217mg for pamidronic acid and 13,870mg for oral bisphosphonates 6 . (medsafe.govt.nz)
  • Practical guidelines for the prevention, diagnosis, and treatment of osteonecrosis of the jaw in patients with cancer. (unicamp.br)
  • In part two of this series, sub-titled 'What Patients Should Know About The Signs And Symptoms As Well As Diagnostic Staging' , we get from these same two medical journal articles some important information about the early signs and symptoms of osteonecrosis of the jaw (ONJ) as well as the extent, or staging, of ONJ upon diagnosis. (drug-injury.com)
  • Biopsy confirmed the diagnosis of bisphosphonate-induced osteonecrosis of the torus palatinus. (rdhmag.com)
  • 6 Bone scanning is useful for early diagnosis and follow-up of osteonecrosis. (cadth.ca)
  • Osteonecrosis: etiology, diagnosis, and treatment. (slideserve.com)
  • The fracture toughness of small animal cortical bone measured using arc-shaped tension specimens: Effects of bisphosphonate and deproteinization treatments. (iu.edu)
  • Biphosphonate related osteonecrosis of the jaw, (BRON), is a pathological condition that is defined as oral bone exposure for a period greater than 8 weeks, in a patient that has been on biphosphonate medication without a history of exposure to external beam radiation. (blumnico.com)
  • The incidence of ONJ associated with oral bisphosphonate treatment is much lower, possibly in the region of one in 60 thousand 5 . (medsafe.govt.nz)
  • In a literature review of case reports, the minimum onset time was 10 months with zoledronic acid, 18 months with pamidronic acid and three years with oral bisphosphonate treatment 6 . (medsafe.govt.nz)
  • American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw - 2014 update. (unicamp.br)
  • As reported previously, there is increasing attention being paid to the association between the use of oral bisphosphonates and osteonecrosis of the jaw (ONJ) , the serious side effect which is commonly called jawbone death, bone decay, or jaw rot. (drug-injury.com)
  • Although spontaneous osteonecrosis is reported in a minority of cases, the majority of patients give a history of some prior dental or oral surgical manipulation. (drug-injury.com)
  • 15 Included under this heading are those orally-related ADRs that are of special interest to oral healthcare providers. (dentalcare.com)
  • 20-22, 24 The causative mechanisms are unclear, but they appear to be related to altered calcium metabolism and concomitant poor oral hygiene-related inflammation. (dentalcare.com)
  • Ulcers with exposure of underlying bone may be caused by osteoradionecrosis (in patients with a history of radiation treatment) or bisphosphonate-related osteonecrosis (in patients taking oral or intravenously administered bisphosphonates). (jcda.ca)
  • But the oral bisphosphonates remain the most widely prescribed antifracture drugs and continue to pose clinical challenges such as measuring therapeutic efficacy and ensuring patient adherence. (ccjm.org)
  • In this issue of the Cleveland Clinic Journal of Medicine , Ashcherkin and colleagues 1 review how bone turnover markers (BTMs) can be used to monitor oral bisphosphonate treatment efficacy and patient adherence. (ccjm.org)
  • However, when possible, any necessary oral surgery should be done before use of bisphosphonates is begun. (merckmanuals.com)
  • People should also continue good oral hygiene while taking bisphosphonates. (merckmanuals.com)
  • With the increasing rate of COVID-19, the general dentists and oral and maxillofacial surgeons must be best prepared and positioned for the early identification and prevention of PC-RONJ (post-COVID-19-related osteonecrosis of the jaw) to avoid permanent deformity," wrote the authors, led by Yehia El-Mahallawy of Alexandria University in Egypt. (drbicuspid.com)
  • On average, oral bisphosphonates were filled for (va.gov)
  • Drug holidays occurred in 14.3% of 35 oral bisphosphonates used for = 5 yr. (va.gov)
  • Gastrointestinal side effects are the major reason for discontinuation of oral bisphosphonates. (va.gov)
  • Medication-related osteonecrosis of the jaw has no unanimously accepted definition or etiology but is generally held to be an oral lesion involving bare mandibular or maxillary bone present for ≥ 8 weeks related to medications. (msdmanuals.com)
  • Oral bisphosphonates are less lipid soluble and result in less accumulation in the bone. (msdmanuals.com)
  • This specific peptide sequence relates to bone turnover because it is the portion that is cleaved by osteoclasts during bone resorption, and its serum levels are therefore proportional to osteoclastic activity at the time the blood sample is drawn. (wikipedia.org)
  • However, the clinical applications of bone turnover markers (BTMs) can extend beyond these roles: BTMs can be utilized to determine when to start or end a bisphosphonate "holiday," and they can also measure treatment response. (ccjm.org)
  • The value of these byproducts of osteoclastic activity lies in the observation that bone turnover decreases in response to treatment with antiresorptive agents such as bisphosphonates. (ccjm.org)
  • Though many patients recover from COVID-19, clinicians should be aware of the potential complications, including osteonecrosis in the maxillofacial region, they can experience after recovery, the authors wrote. (drbicuspid.com)
  • Osteonecrosis of the jaw is primarily associated with high-dose bisphosphonate use in cancer patients. (medscape.com)
  • Between January and August 2021, 12 patients prescribed corticosteroids as treatment for COVID-19 developed spontaneous maxillary osteonecrosis. (drbicuspid.com)
  • Bisphosphonates (BF) pharmacokinetics consist in the osteoclast function interruption, angiogenesis inhibition, as well as blocking any cancer cell line activity together with the interruption of signal transduction [3]. (peertechzpublications.com)
  • 2011. A review of the clinical implications of bisphosphonates in dentistry. (medsafe.govt.nz)
  • Following various periods of COVID-19 disease and its management, each patient showed a mutual clinical picture and spontaneous, unprovoked maxillary osteonecrosis. (drbicuspid.com)
  • A variant clinical picture, which may be present in patients with post-COVID-19-related osteonecrosis of the jaw. (drbicuspid.com)
  • Survivors of COVID-19 may be at risk of developing spontaneous osteonecrosis of the jaw, according to a case series published June 14 in BMC Infectious Diseases . (drbicuspid.com)
  • Because bisphosphonates are preferentially deposited in bone with high turnover rates, it is possible that the levels of bisphosphonate within the jaw bones are selectively elevated. (wikipedia.org)
  • Since the jawbones are in constant use and are characterized by active remodeling, bisphosphonates might accumulate there preferentially, resulting in concentrations that exceed those found elsewhere in the skeleton. (drug-injury.com)
  • Necrotising otitis externa, cholesteatoma and malignancy were considered but with histology, microbiological and CT assessment, bilateral osteonecrosis of the external auditory canal was diagnosed. (bmj.com)
  • What Animal Models Have Taught Us About the Safety and Efficacy of Bisphosphonates in Chronic Kidney Disease. (iu.edu)
  • Although BRON appear to be a potential complication with bisphosphonates , it should not preclude its use when clinically indicated. (blumnico.com)
  • These drugs have a number of side effects, and a new complication known as biphosphonate-associated osteonecrosis (BaO) was recently identified. (bvsalud.org)
  • 2011. Epidemiology and risk factors for osteonecrosis of the jaw in cancer patients. (medsafe.govt.nz)
  • Two recent medical journal articles provide information about how osteonecrosis of the jaw (ONJ) may be caused by Fosamax and other bisphosphonates as well as identify some of the predisposing, or risk, factors for developing ONJ. (drug-injury.com)
  • Several investigators have identified increasing duration of exposure, type of bisphosphonate, older age and prior history of a dental procedure as risk factors for the development of ONJ. (drug-injury.com)
  • Osteonecrosis is, in many cases, subsequent to a dental extraction [7,18] or to other conditions which implicate bone remodeling. (peertechzpublications.com)
  • In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. (bmj.com)
  • These are believed to be the first reported cases of jaw osteonecrosis following SARS-CoV-2 infection. (drbicuspid.com)
  • No cases of osteonecrosis of the jaw were found. (va.gov)
  • Bisphosphonate-induced ONJ is estimated at 0.1% for patients with cancer being treated for associated bone problems that have not had invasive dental procedures 4 . (medsafe.govt.nz)
  • Oro-astral fistula in a patient with surgically related BRON. (blumnico.com)
  • In order to evaluate the risk of osteonecrosis for a patient taking bisphosphonates, use of the CTX biomarker was introduced in 2000 by Rosen. (wikipedia.org)
  • 22, 24 The degree of tissue damage depends on the specific agent, dosage, dosage schedule, and patient-related variables. (dentalcare.com)
  • Clearing the Patient on Bisphosphonates for Dental Procedures: When Should You Do It? (medscape.com)
  • Despite the association of these medicines with ONJ, the benefits of bisphosphonate treatment are still considered to outweigh the risks of experiencing this condition. (medsafe.govt.nz)
  • Osteonecrosis of the jaw (ONJ) Postextraction problems are a subset of dental emergencies that require immediate treatment. (msdmanuals.com)
  • however, it does include stomatitis and ulcerative stomatitis under the category of ADRs related to the gastrointestinal system. (dentalcare.com)
  • 23, 15.8% of bisphosphonates discontinued), predominately gastrointestinal (n? (va.gov)
  • Data that links the incidence of osteonecrosis of the jaw and its etiologic factors are limited, and the incidence of osteonecrosis of the jaw in the general population (ie, those not taking bisphosphonates) is unknown. (medscape.com)
  • Although the management of medical relation osteonecrosis of the jaw is usually provided by colleagues in maxillofacial surgery, it is essential for ENT surgeons to effectively diagnose the various presentations of this condition. (thepmfajournal.com)
  • Many drugs can cause xerostomia (Box C). 20-24 Reduced salivary flow may be related to a drug's parasympatholytic or antimuscarinic effect in the CNS at parasympathetic and some sympathetic ganglia, or at parasympathetic and some sympathetic effector junctions. (dentalcare.com)
  • Her conscientious employer tried hard to calm her down and assured her it was probably related to Fosamax. (rdhmag.com)