Perindopril Arginine, Indapamide, and Amlodipine Fixed Dose Combination Induced Gingival Overgrowth: Two Cases with Specific Clinical Presentation

Yıl 2022, Cilt: 5 Sayı: 1, 96 - 100, 01.01.2022

Melda Pelin Akkitap , Birsay Gümrü , Ömer Birkan Ağralı , Selin Babalı

https://doi.org/10.19127/bshealthscience.943921

Öz

Drug induced gingival overgrowth (DIGO) is a frequent adverse effect of systemic medications. Amlodipine, although accepted as a safe antihypertensive drug due to its longer duration of action with lower dose and fewer adverse reactions compared to other antihypertensive agents, is among the causative drugs. As the aetiology of hypertension is multifactorial, a fixed dose combination containing amlodipine and other antihypertensive agents is currently preferred by physicians as a new treatment approach. The aim of this article is to report two cases of perindopril arginine, indapamide, and amlodipine fixed dose combination induced gingival overgrowth with an emphasis on the specific clinical presentation. Intraoral examination revealed poor oral hygiene, excessive dental plaque accumulation, and erythematous, oedematous, lobulated, enlarged marginal and interdental gingivae prone to bleeding. It was noteworthy that a red band appearance was present on the enlarged labial marginal gingivae in the patients. One month after the drug substitution, proper oral hygiene education and plaque control, and non-surgical periodontal treatment, a marked regression in DIGO and accompanying inflammatory symptoms were observed. Medical and dental practitioners should be aware that antihypertensive drugs used alone or in combination with other agents have the potential to cause gingival overgrowth.

Anahtar Kelimeler

Fixed dose combination, Amlodipine, Gingival overgrowth

Kaynakça

• Ábrahám G, Dézsi CA. 2017. The antihypertensive efficacy of the triple fixed combination of perindopril, indapamide, and amlodipine: The results of the PETRA study. Adv Ther, 34(7): 1753-1763.
• Agrawal AA. 2015. Gingival enlargements: Differential diagnosis and review of literature. World J Clin Cases, 3(9): 779-788.
• Arunachalam LT, Rao S. 2013. Immunolocalization of Bcl-2 oncoprotein in amlodipine-induced gingival overgrowth. Indian J Dent Res, 24(2): 255-260.
• Barclay S, Thomason JM, Idle JR, Seymour RA. 1992. The incidence and severity of nifedipine-induced gingival overgrowth. J Clin Periodontol, 19(5): 311-314.
• Biswas S, Saha A, Das AK, Nair V, Biswas D. 2017. Anti-hypertensive drug induced gingival enlargement - a case report. JODAGH, 10(1): 7-11.
• Caron F, Meurice JC, Dore P, Perault MC, Breux JP, Patte F. 1997. Gingival hyperplasia: a new side effect associated with trimethoprim-sulfamethoxazole (TML-SMX) treatment in pulmonary nocardiosis. Therapie, 52(1): 73-74.
• Dongari-Bagtzoglou A; Research, Science and Therapy Committee, American Academy of Periodontology. 2004. Drug-associated gingival enlargement. J Periodontol, 75(10): 1424-1431.
• Ellis JS, Seymour RA, Steele JG, Robertson P, Butler TJ, Thomason JM. 1999. Prevalence of gingival overgrowth induced by calcium channel blockers: a community-based study. J Periodontol, 70(1): 63-67.
• Gaur S, Agnihotri R. 2018. Is dental plaque the only etiological factor in Amlodipine induced gingival overgrowth? A systematic review of evidence. J Clin Exp Dent, 10(6): e610-e619.
• Godfraind T. 2014. Calcium channel blockers in cardiovascular pharmacotherapy. J Cardiovasc Pharmacol Ther, 19(6): 501-515.
• Gopal S, Joseph R, Santhosh VC, Kumar VV, Joseph S, Shete AR. 2015. Prevalence of gingival overgrowth induced by antihypertensive drugs: A hospital-based study. J Indian Soc Periodontol, 19(3): 308-311.
• Hallmon WW, Rossmann JA. 1999. The role of drugs in the pathogenesis of gingival overgrowth. A collective review of current concepts. Periodontol 2000, 21: 176-196.
• Hassell TM, Hefti AF. 1991. Drug-induced gingival overgrowth: old problem, new problem. Crit Rev Oral Biol Med, 2(1): 103-137.
• Ilgenli T, Atilla G, Baylas H. 1999. Effectiveness of periodontal therapy in patients with drug-induced gingival overgrowth. Long-term results. J Periodontol, 70(9): 967-972.
• James JA, Marley JJ, Jamal S, Campbell BA, Short CD, Johnson RW, Hull PS, Spratt H, Irwin CR, Boomer S, Maxwell AP, Linden GJ. 2000. The calcium channel blocker used with cyclosporin has an effect on gingival overgrowth. J Clin Periodontol, 27(2): 109-115.
• Jorgensen MG. 1997. Prevalence of amlodipine-related gingival hyperplasia. J Periodontol, 68(7): 676-678.
• Khan S, Mittal A, Kanteshwari IK. 2012. Amlodipine induced gingival overgrowth: a case report. NJDSR, 1: 65-69.
• Kimball OP. 1939. The treatment of epilepsy with sodium diphenyl hydantoinate. JAMA, 112(13): 1244-1245.
• Koirala PK, Pradhan S, Gorkhali RS. 2017. Gingival enlargement management in a hospital - a case series. J Nepal Soc Perio Oral Implantol, 1(2): 84-90.
• Lauritano D, Martinelli M, Baj A, Beltramini G, Candotto V, Ruggiero F, Palmieri A. 2019. Drug-induced gingival hyperplasia: An in vitro study using amlodipine and human gingival fibroblasts. Int J Immunopathol Pharmacol, 33: 2058738419827746.
• Livada R, Shiloah J. 2014. Calcium channel blocker-induced gingival enlargement. J Hum Hypertens, 28(1): 10-14.
• Mahajan A, Sood R. 2017. Case report: Oral contraceptives induced gingival overgrowth - a clinical case report. POJ Dent Oral Care, 1(1): 1-5.
• McCord JF, Sloan P, Quayle AA, Hussey DJ. 1992. Phenytoin hyperplasia occurring under complete dentures: a clinical report. J Prosthet Dent, 68(4): 569-572.
• Meisel P, Giebel J, Kunert-Keil C, Dazert P, Kroemer HK, Kocher T. 2006. MDR1 gene polymorphisms and risk of gingival hyperplasia induced by calcium antagonists. Clin Pharmacol Ther, 79(1): 62-71.
• Özdemir Ö, Soylu M, Kütük E. 2002. Gingiva hyperplasia due to amplodipine: Seldom or an easy-to-recover side-effect. Turk Kardiyol Dern Ars, 30: 273.
• Seymour RA, Ellis JS, Thomason JM. 2000. Risk factors for drug-induced gingival overgrowth. J Clin Periodontol, 27(4): 217-223.
• Seymour RA, Thomason JM, Ellis JS. 1996. The pathogenesis of drug-induced gingival overgrowth. J Clin Periodontol, 23(3 Pt 1): 165-175.
• Thomason JM, Seymour RA, Ellis JS, Kelly PJ, Parry G, Dark J, Wilkinson R, Ilde JR. 1996. Determinants of gingival overgrowth severity in organ transplant patients. An examination of the role of HLA phenotype. J Clin Periodontol, 23(7): 628-634.
• Toyo-Oka T, Nayler WG. 1996. Third generation calcium entry blockers. Blood Press, 5(4): 206-208.
• Trackman PC, Kantarci A. 2015. Molecular and clinical aspects of drug-induced gingival overgrowth. J Dental Res, 94(4): 540–546.
• Valcárcel Y, Jiménez R, Hernández V, Arístegui R, Gil A; NOTA Study Group. 2006. Efficacy and safety of amlodipine: a comparative study of hypertensive patients treated at primary- and specialised-care centres. Clin Drug Investig, 26(3):125-133.
• Valsecchi R, Cainelli T. 1992. Gingival hyperplasia induced by erythromycin. Acta Derm Venereol, 72(2): 157.