Regression of nifedipine-induced gingival hyperplasia following switch to a same class calcium channel blocker, isradipine

J Periodontol. 1997 Jul;68(7):645-50. doi: 10.1902/jop.1997.68.7.645.


Patients with nifedipine-induced gingival hyperplasia (GH) often require continued calcium channel blocker therapy. Switches to diltiazem and verapamil have been described; however, these drugs are of a different chemical class and present therapeutic limitations in some patients. The purpose of this study was to evaluate the effect on nifedipine-induced GH of a switch to a dihydropyridine derivative with a low incidence of GH. Fourteen patients with nifedipine-induced GH were given a medical exam and a periodontal exam. The following parameters were assessed: probing depth (PD), gingival margin (GM), gingival thickness (GT), plaque index (PI), and gingival index (GI). Intraoral photographs, study models, and a gingival biopsy for histological examination were taken. Following baseline measures, patients were randomized to continued treatment with nifedipine or an equivalent dose of isradipine in a single-blind fashion. Biweekly periodontal parameters were taken for 8 weeks. At the end of 8 weeks, some patients elected to receive 4 weeks of open label isradipine therapy, with biweekly examination continuing through the open label phase. The isradipine treatment arm showed a mean decrease in PD of 0.59 mm at week 8 (P < 0.05). No other measured parameter (GM, GT, PI, GI) was significantly changed, compared either to baseline or to the alternate treatment arm. Clinically, 60% of patients treated with isradipine exhibited a decrease in hyperplasia, while 66% of patients treated with nifedipine demonstrated an increase in hyperplasia, a significant difference (P < 0.05). When combined with open label data, patients switching therapy to isradipine exhibited an increase in GM (increase in recession) of 0.74 mm from baseline to week 12 (P < 0.05). No patients treated with isradipine exhibited an increase in gingival overgrowth. All patients exhibited adequate control of hypertension. We conclude that in hypertensive patients with nifedipine-induced GH, switching hypertensive therapy to isradipine may result in a regression of GH. When coupled with aggressive oral hygiene treatment, this drug may provide a reasonable option for patients requiring dihydropyridine treatment.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Antihypertensive Agents / adverse effects
  • Antihypertensive Agents / therapeutic use
  • Biopsy
  • Calcium Channel Blockers / adverse effects*
  • Calcium Channel Blockers / therapeutic use
  • Dental Plaque Index
  • Evaluation Studies as Topic
  • Female
  • Follow-Up Studies
  • Gingiva / drug effects
  • Gingiva / pathology
  • Gingival Hyperplasia / chemically induced*
  • Gingival Hyperplasia / pathology
  • Gingival Hyperplasia / prevention & control
  • Gingival Pocket / chemically induced
  • Gingival Pocket / pathology
  • Gingival Recession / chemically induced
  • Humans
  • Hypertension / prevention & control
  • Incidence
  • Isradipine / therapeutic use*
  • Male
  • Middle Aged
  • Models, Dental
  • Nifedipine / adverse effects*
  • Oral Hygiene
  • Periodontal Index
  • Photography
  • Remission Induction
  • Single-Blind Method


  • Antihypertensive Agents
  • Calcium Channel Blockers
  • Nifedipine
  • Isradipine