Nifedipine gingival hyperplasia with

The effects of antihypertensive agents have been evaluated in patients taking ciclosporin. Collectively, dihydropyridine calcium channel blockers that do not affect ciclosporin blood concentrations substantially or at all (felodipine, isradipine, and nifedipine) are usually considered to be the drugs of choice. However, the risk of gingival hyperplasia with nifedipine, which ciclosporin also causes, should be borne in mind. Combination therapy with angiotensin-converting enzyme inhibitors or beta-blockers, or the use of other calcium channel blockers (verapamil or diltiazem) should also be considered, but careful monitoring of ciclosporin blood concentrations is recommended with the latter because they inhibit ciclosporin metabolism. 

The combination of ciclosporin with nifedipine produces an additive on gingival hyperplasia, with an increased prevalence and/or severity (SED-13, 1127) in both children (77,81) and adults (76,80,82). In contrast, verapamil had no significant additional effects on the prevalence or severity of ciclosporin-induced gingival overgrowth (SEDA-21, 385). 

Short-acting nifedipine may rarely cause an increase in the frequency, intensity, and duration of angina in association with acute hypotension. This effect may be obviated by using sustained-released formulations of nifedipine or other dihydropyridines. Other side effects of dihydropyridines include dizziness, flushing, headache, gingival hyperplasia, and peripheral edema. Side effects due to vasodilation such as dizziness, flushing, head-... 

Gingival hyperplasia, similar to that seen with phenytoin and ciclosporin, is a rare but well-recognized adverse effect of nifedipine (88). It has also been reported in patients taking felodipine (89,90), nitrendipine (SEDA-16, 200), and verapamil (91), suggesting that this adverse effect is a class effect. Only one case of gingival hyperplasia related to calcium channel blockers was reported to the Norwegian Adverse Drug Reaction Committee up to 1991, despite their widespread use (92). However,... 

Nifedipine and ciclosporin can cause gingival hyperplasia, which is associated with gingival inflammation and can be mitigated by careful oral hygiene, although this has not been clearly shown. In gingival biopsies from nine... 

Phenytoin causes gingival hyperplasia, which occurs with much greater frequency in children (60%) than in adults (40%), shows no race or sex predilection, and may appear 2 to 3 months after the initiation of therapy. Gingival hyperplasia, which does not occur in the toothless portion of the gum, regresses gradually on discontinuation of the medication. Other medications causing gingival hyperplasia include cyclosporin, nifedipine, diltiazem, verapamil, and nitrendipine (see also Table 10). 

Nifedipine The incidence of gingival hyperplasia has been studied in 31 patients taking ciclosporin, 31 taking ciclosporin - - amlodi-pine, and 31 taking ciclosporin - - nifedipine [23 ]. There was gingival hyperplasia in 16, 18, and 28 respectively furthermore, more of those who took ciclosporin - - nifedipine had severe hyperplasia ( = 7), compared with ciclosporin alone ( = 0) and ciclosporin + amlodipine (n = 5). 

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