Can Amlodipine (calcium channel blocker) cause gum swelling, specifically gingival hyperplasia?

Amlodipine and Gingival Hyperplasia

Yes, amlodipine definitively causes gingival hyperplasia (gingival overgrowth), which is a documented adverse effect of calcium channel blockers, particularly dihydropyridines like amlodipine. 1, 2

Evidence and Mechanism

Gingival hyperplasia is explicitly listed as an adverse reaction in the FDA drug label for amlodipine under gastrointestinal side effects 2. According to clinical guidelines, calcium channel blockers, particularly dihydropyridines like amlodipine, are among the blood pressure medications most commonly associated with this condition 1.

The pathogenesis involves:

• Altered fibroblast metabolism
• Increased collagen production
• Decreased collagenase activity
• Inflammatory changes in gingival tissue 1

Clinical Presentation

Amlodipine-induced gingival hyperplasia typically presents as:

• Diffuse gingival enlargement
• Localized gingival masses
• Erythematous, sessile, soft tissue overgrowth 1
• Firm overgrowth throughout the maxilla and mandible 3

Risk Factors

Several factors increase the risk of developing this condition:

• Poor oral hygiene (major contributing factor)
• Dose of medication (higher doses increase risk)
• Duration of therapy (can develop within months of starting therapy)
• Concurrent medications
• Genetic predisposition 1

Case reports demonstrate that gingival hyperplasia can occur:

• At standard doses (10 mg/day) 3
• Even at lower doses (5 mg/day) 4
• As quickly as within two months of starting therapy 3

Management Options

When gingival hyperplasia is identified in a patient taking amlodipine, consider the following approach:

1. Drug substitution (first-line approach):

   • Switch from amlodipine to another antihypertensive class such as ACE inhibitors, angiotensin receptor blockers (ARBs), or beta-blockers 1
   • Case reports show significant regression of gingival hyperplasia after substitution of amlodipine with alternatives like losartan 5

2. If amlodipine must be continued:

   • Consider dose reduction
   • Implement more frequent professional dental cleaning
   • Emphasize meticulous oral hygiene 1

3. Dental management:

   • Professional scaling and root planing
   • Oral hygiene instruction
   • Chlorhexidine mouthwash (0.12%) twice daily for 2 weeks to reduce inflammation
   • Surgical removal of excess gingival tissue may be necessary in severe cases 1, 6

Prevention

• Monitor patients starting amlodipine therapy for early signs of gingival changes
• Educate patients about the importance of oral hygiene
• Regular dental check-ups for patients on long-term amlodipine therapy 1

Special Considerations

• In transplant patients, concurrent use of cyclosporine A with amlodipine may exacerbate gingival hyperplasia 1
• Patients with pre-existing periodontal disease may be at higher risk 1
• This side effect is often overlooked but can cause significant distress to patients 5

Early recognition and management of this condition can significantly improve patient quality of life and prevent more severe complications requiring surgical intervention.