The Effect of Verapamil on the Prevalence and Severity of Cyclosporine‐Induced Gingival Overgrowth in Renal Allograft Recipients

Abstract

Cyclosporine A (CsA) and verapamil are two agents used in renal transplantation, both of which are suspected of inducing gingival overgrowth. This study was conducted to investigate the effect of verapamil on the severity and prevalence of CsA‐induced gingival overgrowth. Fifty‐one (51) renal transplant recipients (total group) of whom 22 were using only CsA (Group A) and 29 of whom were prescribed CsA + verapamil (Group B) were evaluated for various periodontal and pharmacological parameters. No statistically significant differences were found in age, sex, plaque index, gingival index, calculus index, probing depth, CsA oral dose, CsA whole blood level, duration of CsA therapy, azathioprine dose, and prednisolone dose. Although the prevalence of the gingival overgrowth was more pronounced in CsA + verapamil group compared to CsA group (51.72% vs. 40.91%), the difference was not statistically significant. Similarly, the severity of gingival overgrowth, although more manifest in CsA + Verapamil group than CsA patients (34.24% vs. 28.91%), was not significantly different. Gingival overgrowth scores in the main group, CsA, and CsA + verapamil groups were found to be positively correlated to periodontal probing depths (r = 0.60, r = 0.70, r = 0.52, respectively) and the gingival index (r = 0.60, r = 0.70, r = 0.54, respectively). CsA oral dose, whole blood level, and duration of CsA therapy were not found to be correlated with the gingival overgrowth in either group. Likewise, the dose of verapamil and the duration of verapamil therapy were not correlated with the gingival overgrowth in Group B. This study indicates that verapamil, when prescribed as the calcium channel blocker in renal transplant patients, has no augmenting effect on the severity and the prevalence of CsA‐induced gingival overgrowth. J Periodontol 1996;67:1201–1205.

Adverse Drug Reactions in the Orofacial Region

“…In general, the gingival enlargement develops within a few months of the commencement of drug therapy, is usually generalized, is only partly associated with poor oral hygiene and local plaque accumulation, and responds variably to improved plaque control and/or withdrawal or reduction of drug therapy (Cebeci et al, 1996;Thomason et al, 1996;Jackson and Babich, 1997).…”

Calcium Channel Blocker Induced Gingival Overgrowth

“…At a Veterans Affairs Hospital, the prevalence was highest with nifedipine compared to either nondihydropyridines or control subjects (Figure 3). 18 Coadministration of a calcium antagonist and cyclosporine does not consistently potentiate gingival overgrowth 4,14,19 …”

“…The three classes of drugs associated with gingival overgrowth are antiepileptics (especially phenytoin [Dilantin]), the immunosuppressant cyclosporin, 4 and calcium antagonists 5 . Dihydropyridines (including nifedipine, 6–9 felodipine, 10 nitrendipine, 11 and amlodipine 12 ) and nondihydropyridines, diltiazem, 13 and verapamil, 14–16 have been linked to gingival overgrowth.…”

Low prevalence of gingival overgrowth associated to new imunossupressive protocols with cyclosporin

“…21 In this study, patients that used nifedipine showed a non-significant trend toward greater GO scores.…”