A Rare Case Report of Amlodipine-Induced Gingival Enlargement and Review of Its Pathogenesis

Abstract

Gingival enlargement is a common clinical feature of gingival and periodontal diseases. It is an unwanted side effect of certain systemic drugs given for nondental treatment. It is being reported with three main groups of drugs like calcium channel blockers (CCBs), immunosuppressants, and anticonvulsants. Among calcium channel blockers, nifedipine causes gingival hyperplasia in about 10% of patients, whereas the incidence of amlodipine-, a third generation calcium channel blocker, induced gingival hyperplasia is very limited. There are very few reports of amlodipine-induced gingival enlargement at a dose of 5 mg. We report a case of amlodipine-induced gingival enlargement in a 45-year-old hypertensive patient taking amlodipine at a dose of 5 mg.

Drug-induced gingival overgrowth: A critical insight into case reports from over two decades

“…Reported cases of gingival enlargements were induced by different drugs; CCBs (50/119 – of which amlodipine-25;[8910111213141516171819202122232425262728] nifedipine-13;[26293031323334353637383940] verapamil-4;[41] felodipine-2;[4243] nisoldipine-1;[44] manidipine-1;[45] and unspecified CCBs-4[46]); phenytoin (11/119);[4748495051525354555657] cyclosporine (31/119);[3546585960616263646566676869707172737475] phenobarbital (4/119);[767778] sodium valproate (3/119 - including one report of congenital drug-induced gingival hyperplasia);[798081] d-penicillamine (2/119);[82] combination oral contraceptive pill-lynestrenol and ethinyl estradiol (1/119);[83] vigabatrin (1/119). [84] Cases of gingival enlargement after combination drug therapy have also been reported; a combination of cyclosporine and CCBs (11/119);[354685...…”

“…in 2006[21] and Joshi and Bansal in 2013. [10] Furthermore, a case report by Sunil et al . in 2012[29] suggests that severity of the enlargement is dose dependent.…”

“…in 2012[12] reported a case of gingival overgrowth in a hypertensive patient under amlodipine therapy, in which, change of medication resulted in regression of the overgrowth within 3 months without any need for surgical intervention. Joshi and Bansal in 2013[10] reported that gingival overgrowth in a hypertensive patient under amlodipine therapy showed drastic improvement within 1.5 months after change of drug. Similarly, Ramsdale et al .…”

Amlodipine induced gingival hyperplasia: a case report

“…1 It is structurally similar to nifedipine and pharmacodynamically comparable to it. 2 In hypertension, the therapeutic dose of amlodipine is 5 mg once or twice daily or 10 mg once daily.…”

Gingival Overgrowth on Chronic use of Amlodipine: A Case Report

“…The prevalance of amlodipine induced gingival overgrowth is less when compared to other CCBs used in hypertensive and other cardiac disease patients. 4 The pharmacology and the pharmacokinetic details of amlodipine is present in Table 1 Proper maintenance of oral hygene, dechallenge of the suspected drug and switch over to an alternative, scaling and root planning and the surgical excision of the overgrown gingival tissue are the management options for this ADR. 2 There are very less reports on gingival hyperplasia followed by chronic use of amlodipine at a dose of 5 mg.…”