dihydropyridines and Gingival-Hyperplasia

Topics: Animals; Cyclosporins; Dihydropyridines; Gingival Hyperplasia; Humans; Phenytoin

The use of calcium channel blockers (CCBs) is associated with gingival enlargement, which adversely affects oral function, hygiene and aesthetics. Although CCB-induced gingival enlargement is a known adverse effect, it is rarely or never caused by some CCBs. In this paper, we report the case of a late 80's female patient with hypertension who experienced amlodipine-induced gingival enlargement. The patient's antihypertensive medication was changed from amlodipine to another CCB of the same class, benidipine, which has not been reported to cause gingival enlargement. The patient also received periodontal therapy. A significant improvement in gingival enlargement was noted, and blood pressure control was maintained. This case indicates that it might be beneficial for patients with hypertension presenting CCB-induced gingival enlargement to switch from the CCB that caused gingival enlargement to another CCB with little to no risk.

Topics: Amlodipine; Antihypertensive Agents; Calcium Channel Blockers; Dihydropyridines; Female; Gingival Hyperplasia; Gingival Overgrowth; Humans; Hypertension

Topics: Calcium Channel Blockers; Child, Preschool; Dihydropyridines; Gingiva; Gingival Hyperplasia; Humans; Male

To study the effect of the dose and type of calcium channel blockers (CCBs) on the risk of gingival hyperplasia and to quantify this association.. The study was conducted within the Integrated Primary Care Information Project in The Netherlands. A nested case-control study was designed within a cohort of all patients who were new users of either CCBs or drugs interacting with the renin-angiotensin system (RAS). Cases were all individuals with a validated diagnosis of gingival hyperplasia. Controls were matched on age, gender and index date.. Within the study population, 103 cases of gingival hyperplasia were identified and matched to 7677 controls. The risk of gingival hyperplasia was higher in current users of CCBs [adjusted odds ratio (OR(adj)) 2.2, 95% confidence intervals (95% CI): 1.4-3.4], especially in dihydropyridines (OR(adj) 2.1, 95% CI: 1.3-3.5) and benzothiazepine derivatives (OR(adj) 2.9, 95% CI: 1.3-6.5) than in RAS drug users. The risk increased in patients using more than the recommended daily dose (OR(adj) 3.0, 95% CI: 1.6-5.5) and when the duration of current use was <1 month (OR(adj) 5.2, 95% CI: 2.1-12.6).. This study shows that the risk of gingival hyperplasia is twofold higher in current users of CCBs than in users of RAS drugs. The association was dose dependent and the highest for dihydropyridines or benzothiazepine derivates.

Topics: Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Calcium Channel Blockers; Case-Control Studies; Confounding Factors, Epidemiologic; Dihydropyridines; Dose-Response Relationship, Drug; Female; Gingival Hyperplasia; Humans; Logistic Models; Male; Middle Aged; Thiazepines

Topics: Calcium Channel Blockers; Dihydropyridines; Diltiazem; Gingival Hyperplasia; Humans; Nifedipine; Verapamil

Topics: Animals; Calcium Channel Blockers; Dihydropyridines; Disease Models, Animal; Dogs; Female; Gingival Hyperplasia; Humans; Male; Testosterone

Gingival hyperplasia is a known side effect in patients treated with diphenylhydantoin, cyclosporin and the calcium channel antagonists. The present study proposes a mechanism by which calcium channel antagonists may induce gingival hyperplasia. The calcium antagonist induces blockage of the aldosterone synthesis in zona glomerulosa of the adrenal cortex since this pathway is calcium-dependent, cyclic nucleotide-independent. This may produce a feedback stimulation of an increase in pituitary secretion of ACTH which affects zona glomerulosa hyperplasia. This hyperplasia is merely related by accumulation of steroid intermediate products (androgens) that are transformed to testosterone because of an increase in 17-alpha-hydroxylase enzyme activity. Elevated levels of testosterone may act on the gingival cells and matrix to produce gingival hyperplasia.

Topics: Adrenocorticotropic Hormone; Animals; Calcium Channel Blockers; Dihydropyridines; Gingival Hyperplasia; Humans; Models, Biological; Testosterone; Zona Glomerulosa

No data exist on any association between combined cyclosporine A (Cy A) and dihydropyridine (DHP) medication and the effect of periodontal treatment on the occurrence of gingival overgrowth (GO) among renal transplant recipients. Clinical data on 27 renal transplant recipients treated with Cy A are presented here, including determinations of serum creatinine, whole blood Cy A concentration, existence of DHP treatment, and periodontal status. GO was classified into four categories according to the clinical changes: score 0 = no GO; score 1 = mild GO; score 2 = moderate GO; and score 3 = severe GO. All participants received hygiene phase periodontal treatment and gingivectomies were performed on 10 who originally had score 2 or 3 GO and pocketing. Fourteen (14) of the recipients had no overgrown gingiva or less than at the initial examination, and none of them had GO score 2 or 3 at the time of re-examination (group A). Thirteen (13) participants had more overgrown gingiva than initially or developed score 2 GO after gingivectomies (group B). Group B included significantly more DHP-medicated recipients than group A (6/13 and 1/14 respectively; P < 0.03). The concomitant administration of Cy A and DHP resulted in a significantly increased percentage of score 2 overgrown gingival units as compared with Cy A alone (P < 0.03). It is concluded that combined treatment with Cy A and DHP is a significant risk factor for progression or recurrence of GO after periodontal treatment among susceptible patients.

Topics: Adult; Cyclosporine; Dihydropyridines; Female; Gingival Hyperplasia; Gingivectomy; Humans; Kidney Transplantation; Male; Periodontitis; Risk Factors

Using the model of oxodipine-induced gingival hyperplasia in beagle dogs, we investigated the collagen fibres of the hyperplastic gingiva by measuring the polarization colours from Picrosirius-red stained sections. The predominant polarization colours of the thick collagen fibres (1.6-2.4 microns diameter) of male oxodipine-treated dogs were greenish-yellow to yellow, while in controls and in female oxodipine-treated dogs, the same size fibres mostly appeared orange and red. These differences may be indicative of gender variation in the genesis of hyperplastic gingiva in calcium channel blocker treated dogs.

Topics: Animals; Azo Compounds; Collagen; Dihydropyridines; Dogs; Female; Gingiva; Gingival Hyperplasia; Male; Microscopy, Polarization; Picrates; Sex Factors

Topics: Calcium Channel Blockers; Dihydropyridines; Gingival Hyperplasia; Humans; Verapamil

Oxodipine, a new calcium channel blocker, induced gingival hyperplasia in rats. This is the first time that a calcium channel blocker has been documented as resulting in gingival hyperplasia in rats. In contrast to diphenylhydantoin, the hyperplastic changes induced by oxodipine were not precipitated by any prior irritation. The histology consisted of purely fibroblastic proliferation without infiltrate of inflammatory cells.

Topics: Animals; Calcium Channel Blockers; Dihydropyridines; Disease Models, Animal; Female; Gingival Hyperplasia; Male; Rats; Rats, Inbred F344

Topics: Animals; Dihydropyridines; Disease Models, Animal; Dogs; Gingival Hyperplasia

Topics: Animals; Dihydropyridines; Dogs; Female; Gingiva; Gingival Hyperplasia; Male; Time Factors

Subchronic oral exposure of dogs to Oxodipine, a new calcium channel blocker of the dihydropyridine-type, resulted in dose-related gingival hyperplastic changes. The doses at which an effect was elicited were 24 and 73 times the intended therapeutic dose for man. The effects were first noted after 7 weeks of treatment, and were limited to the high and intermediate dose groups of both sexes. Macroscopically, a generalized enlargement of the maxillary and mandibular facial and lingual gingivae were noted. The histological changes were similar to those described in man for Nifedipine and hydantoin-related drugs. An increase in the activity of alkaline phosphatase and a decrease in alanine aminotransferase was demonstrated. This article is the first to describe gingival hyperplasia in dogs induced in a dose-dependent manner by a calcium channel blocker.

Topics: Alanine Transaminase; Alkaline Phosphatase; Animals; Calcium Channel Blockers; Dihydropyridines; Dogs; Dose-Response Relationship, Drug; Female; Gingiva; Gingival Hyperplasia; Male; Nifedipine