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Indian Heart J. 2016 May-Jun; 68(3): 431.
Published online 2016 April 14. doi:  10.1016/j.ihj.2016.03.036
PMCID: PMC4911459

Gingival overgrowth due to amlodipine

K.M. Krishnamoorthy[low asterisk]
Additional Professor, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India

Dear Sir,

We read with interest the recent report on gingival overgrowth due to amlodipine.1 We would like to make a few remarks while sharing our experience with this condition in an elderly lady. While on amlodipine, she developed insidious gingival overgrowth (Fig. 1) without any signs of inflammation. This was completely reversible which may not always be the case.2

Fig. 1
Figure showing gingival overgrowth due to amlodipine.

‘Overgrowth’ is the preferred term rather than gingival hypertrophy.3 Unattended, it may even lead to tooth loss. Treating and maintaining patients on amlodipine in periodontal practice involves considerable extra treatment and cost.2 Overgrowth may not always be a class effect, because overgrowth has disappeared in a person who switched over to isradipine from nifedipine.4 Half of the patients experience long-term recurrence.2

The pathogenesis is related to its mechanism of action. Amlodipine reduces Ca2+ cell influx, leading to a reduction in the uptake of folic acid, limiting the production of active collagenase.5 Collagen is normally degraded by collagenases. Because of reduction in degradation, collagen accumulates in connective tissue matrix of gingiva.

References

1. Tomar L.R., Aggarwal A. Missing diagnosis: gingival hypertrophy due to amlodipine. Indian Heart J. 2015;67:491–492. [PubMed]
2. Fardal Ø., Lygre H. Management of periodontal disease in patients using calcium channel blockers – gingival overgrowth, prescribed medications, treatment responses and added treatment costs. J Clin Periodontol. 2015;42:640–646. [PubMed]
3. Marshall R.I., Bartold P.M. A clinical review of drug induced gingival overgrowth. Aust Dent J. 1999;44:219–232. [PubMed]
4. Westbrook P., Bednarczyk E.M., Carlson M. Regression of nifedipine-induced gingival hyperplasia following switch to a same class calcium channel blocker isradipine. J Periodontol. 1997;68:645–650. [PubMed]
5. Barclay S., Thomason J.M., Idle J.R. The incidence and severity of nifedipine-induced gingival overgrowth. J Clin Periodontol. 1992;19:311–314. [PubMed]

Articles from Indian Heart Journal are provided here courtesy of Elsevier