Gingival Hyperplasia and Calcium Channel Blockers

To the Editor:

We read with interest the case report of Tajani and Nesbitt ¹ regarding severe gingival hyperplasia (GH) in a hypertensive patient who had received multiple calcium channel blockers (CCBs). The problem of GH with CCBs, although well established in the literature, ² has not been studied in depth in hypertensive patients, possibly due to the multiple options for alternative classes of antihypertensive medications.

In renal transplant recipients, the combination of cyclosporine as an antirejection agent, especially with CCBs as antihypertensives, may result in GH in a significant number of patients. The options for these patients are (1) to convert immunosuppression from cyclosporine to tacrolimus or (2) to stop CCBs, although the second option may not fully reduce GH. However, after the initial report by Wahlstrom and colleagues, ³ there have been many reports ⁴ , ⁵ regarding the beneficial role of azithromycin, a macrolide antibiotic, which can reverse or accelerate the recovery from GH in renal transplant recipients who are using cyclosporine and CCBs. This is true even for a case of severe GH described by Tajani and Nesbitt. ¹

We have used this medication with success in renal transplant recipients. We have also treated 3 hypertensive patients with GH induced by CCBs (nifedipine, amlodipine, and verapamil) with a short regimen of azithromycin (250 mg for 3 days). These patients were intolerant to other classes of antihypertensives, or they were well controlled by CCBs and did not wish to change them. No patient presented with any side effects, and the improvement in GH was apparent after 2 to 3 weeks. In one patient with severe GH, a second course was given after 1 month in order to achieve full GH regression. Thus, in hypertensive patients with GH, a trial with azithromycin might be of value before discontinuing CCBs and before initiation of any dental surgical interventions.—