Amlodepine induced gingival enlargement - presentation of a clinical case series

Objectives: Gingival enlargement as an adverse effects of drugs has been found to be long associated with the use of anticonvulsants; phenytoin, anti-hypertensives; calcium channel blockers and immunosuppressants; cyclosporine. Nifedepine was found to cause gingival overgrowth with an incidence ranging from 15-85%. However, Amlodepine a relatively newer agent of the same group which is being routinely and vastly prescribed either alone or as part of combination therapy to middle to older aged adults has also been found to exhibit this adverse effect with very few cases reported till date. The effect of the dose of amlodepine on the severity of gingival enlargement needs to be assessed. Study design: A clinical presentation of a series of five cases in the age range of 45-65 yrs with gingival over-growth as a side effect of therapy with amlodepine is presented with prescription of variable doses of 2.5 mg, 5 mg and 10 mg per day. A brief review on the pathogenesis of this condition, commonly associated etiological mechanisms and sequence of periodontal therapy rendered have also been included. Conclusion: Irrespective of the dose of amlodepine administered, gingival enlargement continues to be a predominant side effect in all of the five cases presented. The accentuated gingival contours accumulate plaque leading further to the destruction of the underlying periodontium. Dental professionals need to identify and then guide the patient to seek necessary medical intervention.