Amlodipine and Nifedipine Used With Cyclosporine Induce Different Effects on Gingival Enlargement

López‐Pintor, Rosa María; Hernández, Gonzalo; Arriba, Lorenzo de; Morales, J. M.; Jiménez, Carlos María Gómez-Centurión; Andrés, Amado

doi:10.1016/j.transproceed.2009.06.052

Cited by 13 publications

(12 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…87 Calcium channel blockers have been associated with worse gingival hyperplasia when combined with CsA. 88 In general, we continue CsA in the setting of modest increases in creatinine, with careful monitoring of renal function and adjustment of dosing to achieve target CsA levels. Fine-tuning of the CsA dose to the lower end of the therapeutic range, optimization of blood pressure control, adequate hydration, and avoidance of other nephrotoxic agents can improve the tolerability and allow for continued CsA use.…”

Section: Immunosuppression Administrationmentioning

confidence: 99%

How I treat acquired aplastic anemia

Scheinberg

Young

2012

Blood

356

333

View full text Add to dashboard Cite

Survival in severe aplastic anemia (SAA) has markedly improved in the past 4 decades because of advances in hematopoietic stem cell transplantation, immunosuppressive biologics and drugs, and supportive care. However, management of SAA patients remains challenging, both acutely in addressing the immediate consequences of pancytopenia and in the long term because of the disease's natural history and the consequences of therapy. Recent insights into pathophysiology have practical implications. We review key aspects of differential diagnosis, considerations in the choice of firstand second-line therapies, and the management of patients after immunosuppression, based on both a critical review of the recent literature and our large personal and research protocol experience of bone marrow failure in the Hematology Branch of the National Heart, Lung, and Blood Institute. (Blood. 2012;120(6): 1185-1196) IntroductionUntil the 1970s, severe aplastic anemia (SAA) was almost uniformly fatal, but in the early 21st century most patients can be effectively treated and can expect long-term survival. Nevertheless, making a diagnosis and selecting among treatment options are not straightforward, and both physicians and patients face serious decision points at the outset of their disease to years after its presentation. We summarize our approach to SAA, with recommendations based on decades of experience in the clinic as well as a critical review of the literature. Unfortunately, as a rare disease, there are few large trials of any kind and even fewer randomized controlled studies, which usually provide the best evidence to guide practice in the clinic. Pathophysiology as basis of diagnosis and treatmentThe pathophysiology responsible for marrow cell destruction and peripheral blood pancytopenia has itself been inferred from the results of treatment in humans, with substantial in vitro and animal model support. The reader is referred to more didactic textbook chapters and formal reviews on these topics. [1][2][3][4] The success of HSCT in restoring hematopoiesis in SAA patients implicated a deficiency of HSCs. Hematologic improvement after immunosuppressive therapy (IST), initially in the context of rejected allogeneic grafts and then in patients receiving only IST, implicated the immune system in destruction of marrow stem and progenitor cells. Immune-mediated marrow failure can be modeled in the mouse by the "runt" version of GVHD, with HSC depletion and hematopoietic failure induced by infusion of lymphocytes mismatched at major or minor histocompatibility loci. 5,6 Genetics influences both the immune response and its effects on the hematopoietic compartment. There are histocompatibility gene associations with SAA, 7 and some cytokine genes may be more readily activated in patients because of differences in their regulation, as suggested by polymorphisms in promoter regions. 8 An inability to repair telomeres and to maintain the marrow's regenerative capacity, resulting from mutations in the complex of genes responsible for tel...

show abstract

Section: Immunosuppression Administrationmentioning

confidence: 99%

How I treat acquired aplastic anemia

Scheinberg

Young

2012

Blood

356

333

View full text Add to dashboard Cite

show abstract

“…Medicación concomitante con BCC y CsA o Tcr ha mostrado un incremento en la prevalencia y severidad del agrandamiento gingival (23,26,27). Ellis y colaboradores, reportaron que el agrandamiento en sujetos que toman Tcr fue mayor cuando se utilizó terapia combinada con BCC (23).…”

Section: Discussionunclassified

Agrandamiento gingival inducido por medicamentos. Reporte de un caso clínico / Drug-Induced Gingival Overgrowth. A Clinical Case Report

2018

View full text Add to dashboard Cite

RESUMENAntecedentes: el agrandamiento gingival inducido por medicamentos es una condición clínica frecuente en pacientes que ingieren anticonvulsivantes, inmunosupresores y bloqueadores de los canales de calcio. La prevalencia de agrandamiento gingival inducido por medicamentos es de 3 -20 % en comparación con otras condiciones gingivales inflamatorias. Todos estos medicamentos producen lesiones clínicas y características histológicas indistinguibles unas de otras, que llegan a comprometer la función y la estética de los pacientes afectados. Propósito: Describir el manejo terapéutico integral y el seguimiento a 12 meses de una paciente con agrandamiento gingival inducido por tacrolimus y amlodipino. Descripción del caso: Paciente de 22 años con discapacidad mental limítrofe, receptora de trasplante renal fue remitida al servicio de Odontología del Hospital 2 Infantil Universitario de San José (Bogotá, Colombia) por presentar agrandamiento gingival. El examen clínico mostró un índice de placa de O'Leary del 84,3 %, inflamación generalizada y bolsas gingivales de 4 a 6 mm. El protocolo de tratamiento periodontal fue revisado por el equipo de trasplante renal e incluyó: trabajo con la familia para red de apoyo, diseño de un programa personalizado de higiene oral, gingivectomía y mantenimientos periodontales periódicos. Esta estrategia terapéutica permitió reducir el índice de placa y lograr un resultado clínico favorable. Conclusión: La condición sistémica y psicológica de la paciente determinó desarrollar un plan de tratamiento ajustado a sus necesidades. Pacientes susceptibles deben ser instruidos sobre la importancia de tener unas prácticas adecuadas de higiene oral y ameritan ser incluidos en un programa de mantenimiento periodontal. PALABRAS CLAVEAgrandamiento gingival; amlodipino/efectos adversos; reporte de caso; tacrolimus/uso terapéutico; trasplante renal/complicaciones ÁREAS TEMÁTICAS diagnóstico clínico; farmacología; medicina oral; periodoncia ABSTRACT Background: drug-influenced gingival enlargement, is a frequent clinical condition in patients who ingest anticonvulsant, immunosuppressant and calcium channel blockers. The prevalence of gingival overgrowth due to prescribed medications ranges from 3% to 20% in comparison to other gingival inflammatory conditions. These drugs produce clinical lesions and histological characteristics that are indistinguishable from one another, which compromise the function and aesthetics of the affected patients. Purpose: To describe the total therapeutic management and the clinical follow up at 12-months from a patient with gingival enlargement induced by tacrolimus and amlodipine. Case description: A 22-year-old patient with borderline mental disability who received a kidney transplant was referred to San Jose Hospital -Medical Dental Unit (Bogotá, Colombia) presenting gingival enlargement. The clinical examination revealed an O'Leary plaque index of 84.3%, generalized inflammation, and gingival pockets of 4 to 6 mm. The periodontal treatment protocol was reviewed by t...

show abstract

“…The prevalence rate of GE occurred when amlodipine was used alone has been shown to be between 1.7% and 3.3% (2, 17, 18). …”

Section: Discussionmentioning

confidence: 99%

“…However, its replacement with another medication might be a practical solution (1). CsA discontinuation is the simplest approach to reduce GE (2). …”

Section: Discussionmentioning

confidence: 99%

The Impact of Amlodipine on Gingival Enlargement After Kidney Transplantation

Rahimi

Einollahi

et al. 2012

Nephro Urol Mon

View full text Add to dashboard Cite

Background: Although cyclosporine (CsA) and calcium channel blockers (CCBs) parallel to each other may provoke gingival enlargement (GE), there are few considerations about combined effects of CsA and CCBs on gingival tissues.Objectives: This study aimed to determine prevalence of GE among renal transplant recipients and to compare its occurrence in patients who received only CsA and those who were on CsA and amlodipine.Patients and Methods: We conducted a prospective randomized case-control trial including 213 renal transplant recipients between February 2010 and August 2010. They were randomly divided into two groups including control group (on continuous treatment with CsA alone; n = 112) and trial group (treated with combined CsA and amlodipine; n = 101). Buccal, lingual, and inter-proximal membranes at last 12 anterior teeth were assessed for GE and packet depth (PD) using Gingival Index of McGaw and others, and Packet Index of Turesky–Gilmore–Glickman, respectively.Results: Marked GE was observed in 26 patients (25.7%) in trial group and only in 4 individuals (3.6%) in control group (P = 0.000). In logistic regression analysis, obese (OR = 3, P = 0.04), older (OR = 2.8, P = 0.03), and female (OR = 1.3, P = 0.03) recipients as well as who received high dose amlodipine (OR = 4.4, P = 0.000) were at risk for marked GE.Conclusions: There is a strong correlation between GE, in particular marked GE, and combination therapy with CsA and amlodipine in transplant patients compared to those treated by CsA alone. We suggest CsA dose reduction may restrain this adverse effect.

show abstract

Amlodipine and Nifedipine Used With Cyclosporine Induce Different Effects on Gingival Enlargement

Cited by 13 publications

References 7 publications

How I treat acquired aplastic anemia

How I treat acquired aplastic anemia

Agrandamiento gingival inducido por medicamentos. Reporte de un caso clínico / Drug-Induced Gingival Overgrowth. A Clinical Case Report

The Impact of Amlodipine on Gingival Enlargement After Kidney Transplantation

Contact Info

Product

Resources

About