title: 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.
authors.affiliation: Department of Periodontics, School of Dentistry, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: P
authors.initials: P
authors.lastname: Westbrook
authors.forename: E M
authors.initials: EM
authors.lastname: Bednarczyk
authors.forename: M
authors.initials: M
authors.lastname: Carlson
authors.forename: H
authors.initials: H
authors.lastname: Sheehan
authors.forename: N F
authors.initials: NF
authors.lastname: Bissada
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001706:Biopsy; D002121:Calcium Channel Blockers / Q000009:adverse effects* / Q000627:therapeutic use; D003774:Dental Plaque Index; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000187:drug effects / Q000473:pathology; D005885:Gingival Hyperplasia / Q000139:chemically induced* / Q000473:pathology / Q000517:prevention & control; D005888:Gingival Pocket / Q000139:chemically induced / Q000473:pathology; D005889:Gingival Recession / Q000139:chemically induced; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D015994:Incidence; D017275:Isradipine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D003765:Models, Dental; D009543:Nifedipine / Q000009:adverse effects*; D009910:Oral Hygiene; D010512:Periodontal Index; D010781:Photography; D012074:Remission Induction; D016037:Single-Blind Method
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D009543:Nifedipine; D017275:Isradipine