Incidence of Gingival Overgrowth Caused by Calcium Channel Blocker

Objectives: Gingival overgrowth caused by nifedipine is a well-known adverse effect. Concerning other calcium channel blockers, a several drugs have been reported as a causative drug. However, since the incidence of gingival overgrowth remains poorly defined, the incidences of 13 calcium channel blockers were determined. Patients and Methods: Dental patients (n = 1,315) who received amlodipine (n = 158), barnidipine (n = 25), benidipine (n = 28), cinnarizine (n = 46), diltiazem (n = 184), flunarizine (n = 32), manidipine (n = 109), nicardipine (n = 214), nifedipine (n = 307), nilvadipine (n = 58), nisoldipine (n = 87), nitrendipine (n = 25) or velapamil (n = 41) for more than 3 months were surveyed to determine the drug-induced gingival overgrowth. Patients taking other drugs known to induce gingival overgrowth or presenting with complaint of drug-induced gingival overgrowth were excluded from this study. Clinical diagnosis of drug-induced overgrowth was verified by disappearance or decreased severity of gingival overgrowth after withdrawal of the causative drug. Results: The gingival overgrowth was found in patients receiving amlodipine, diltiazem, manidipine, nicardipine, nifedipine and nisoldipine, but not by barnidipine, benidipine, cinnarizine, flunarizine, nilvadipine, nitrendipine and velapamil. The clinical finding of gingival overgrowth was the same among drugs. The highest incidence of gingival overgrowth was obtained by nifedipine (8.1%), followed by diltiazem (4.3%), amlodipine (1.9%), manidipine (1.8%), nisoldipine (1.1%) and nicardipine (0.5%). The incidence of nifedipine-induced gingival overgrowth was significantly higher than those of amlodipine, manidipine nicardipine and nisoldipine, but not diltiazem. Conclusions: Gingival overgrowth induced by amlodipine, diltiazem, manidipine, nicardipine, nifedipine and nisoldipine was found in surveyed patients, of which incidence of overgrowth varied among the drugs. Calcium channel blocker-induced gingival overgrowth, especially by nifedipine, appears more frequently and is now not a rare adverse effect.