Dental drugs with proarrhythmic risk in patients with Brugada syndrome: precaution instructions for practices in the field of orofacial pain

Abstract

Orofacial pain, diagnosed and treated in a subfield of dentistry, highly relies on long-term psychotropic, neuromodulating, and analgesic regimens that have the potential to alter cardiac ion channels and autonomic tone. In patients with inherited arrhythmia syndromes such as Brugada syndrome (BrS), these drugs may unmask a type 1 Brugada electrocardiographic pattern or trigger malignant ventricular arrhythmias and sudden cardiac death, yet most dental guidance addresses only short-term use of local anesthetics. In this narrative review, we synthesize evidence on the arrhythmogenic potential of medications used for orofacial pain-non-steroidal anti-inflammatory drugs, tricyclic antidepressants, anticonvulsants, and primary headache therapies. Finally, we propose a pragmatic risk-stratified approach for orofacial pain specialists. Incorporating channelopathy-specific precautions into orofacial pain pharmacotherapy may reduce drug-induced ventricular arrhythmias and sudden cardiac death while preserving effective long-term pain control.