NIFEDIPINE AGGRAVATES CYCLOSPORINE-A-INDUCED GINGIVAL HYPERPLASIA

Gingival hyperplasia is a common side-effect of immunosuppression with cyclosporine A. Nifedipine is often used to control hypertension in k idney graft recipients. Analysis of gingival status in 106 children tr ansplanted at our centre, and treated either with azathioprine, cyclos porine A or both, revealed significantly higher degrees of gingival ov ergrowth in those children receiving a combination of cyclosporine A a nd nifedipine compared with those children treated with cyclosporine A or nifedipine alone. Seven children undergoing gingivectomy at our ce ntre over the past few years had received this combination. After a ch ange in the antihypertensive regimen, avoiding long-term nifedipine me dication, and improved dental care with chlorhexidine gel, we noted a reduction in the degree of gingival hyperplasia. In the majority of pa tients, nifedipine could be replaced by a single drug, usually hydrala zine. We therefore recommend avoiding calcium channel blockers in the long-term management of hypertension in patients receiving cyclosporin e.