Regression of Nifedipine‐Induced Gingival Hyperplasia Following Switch to a Same Class Calcium Channel Blocker, Isradipine

Abstract

Patients with nifedipine-induced gingival hyperplasia (GH) often require continued calcium channel blocker therapy. Switches to diltiazem and verapamil have been described; however, these drugs are of a different chemical class and present therapeutic limitations in some patients. The purpose of this study was to evaluate the effect on nifedipine-induced GH of a switch to a dihydropyridine derivative with a low incidence of GH. Fourteen patients with nifedipine-induced GH were given a medical exam and a periodontal exam. The following parameters were assessed: probing depth (PD), gingival margin (GM), gingival thickness (GT), plaque index (PI), and gingival index (GI). Intraoral photographs, study models, and a gingival biopsy for histological examination were taken. Following baseline measures, patients were randomized to continued treatment with nifedipine or an equivalent dose of isradipine in a single-blind fashion. Biweekly periodontal parameters were taken for 8 weeks. At the end of 8 weeks, some patients elected to receive 4 weeks of open label isradipine therapy, with biweekly examination continuing through the open label phase. The isradipine treatment arm showed a mean decrease in PD of 0.59 mm at week 8 (P < 0.05). No other measured parameter (GM, GT, PI, GI) was significantly changed, compared either to baseline or to the alternate treatment arm. Clinically, 60% of patients treated with isradipine exhibited a decrease in hyperplasia, while 66% of patients treated with nifedipine demonstrated an increase in hyperplasia, a significant difference (P < 0.05). When combined with open label data, patients switching therapy to isradipine exhibited an increase in GM (increase in recession) of 0.74 mm from baseline to week 12 (P < 0.05). No patients treated with isradipine exhibited an increase in gingival overgrowth. All patients exhibited adequate control of hypertension. We conclude that in hypertensive patients with nifedipine-induced GH, switching hypertensive therapy to isradipine may result in a regression of GH. When coupled with aggressive oral hygiene treatment, this drug may provide a reasonable option for patients requiring dihydropyridine treatment.

Calcium Channel Blocker Induced Gingival Overgrowth

“…Discontinuation of the calcium antagonist or switching to another drug often results in improvement of the hyperplasia obviating the need for dental intervention. In one study, 22 60% of isradipine‐treated patients demonstrated regression of overgrowth while 66% of nifedipine‐treated patients progressed ( p <0.05). In severe cases, gingivectomy may be needed 21 .…”

Calcium channel blockers: pharmacology and place in therapy of pediatric hypertension

“…Incidence rates vary between the CCBs listed, and appear to be lowest with amlodipine and greatest with nifedipine. Regression has been reported following a change in therapy from nifedipine to isradipine [97]. Lower extremity edema has also been reported with many CCBs, with an increased incidence at higher doses.…”

Prevalence and Risk of Gingival Enlargement in Patients Treated With Nifedipine

“…25,81 In our case, alternatives to nifedipine include the other dihydropyridines or non-dihydropyridine calcium antagonists, although verapamil 24,25 and diltiazem 29,30 also have been related to gingival enlargement. As an example, Westbrook et al 82 reported that replacing nifedipine by isradipine reduced the severity of gingival enlargement in 60% of patients. Metronidazole and azithromycin have been recently used to treat gingival enlargement induced by cyclosporin A, resulting in a reduction or even resolution of the overgrowth.…”