Acute Necrotizing Pancreatitis Associated With Orally Disintegrating Formulation of Olanzapine

Vaidyanathan, Sivapriya; Subramanian, Karthick; Bharadwaj, Balaji; Das, Saibal; Kola, G.; Maroju, Nanda Kishore

doi:10.1097/jcp.0000000000001081

Cited by 5 publications

(11 citation statements)

References 9 publications

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“…Clinicians in all cases were confident in ruling out any confounders of acute pancreatitis, in particular alcohol, gallstones and other drugs. The majority of the cases made use of radiological investigation to rule out cholelithiasis [1][2][3][4][5][6][7][8] (one exception was a patient with a previous history of cholecystectomy within the decade prior to presentation 9 ). In addition, a concurrent accidental verapamil overdose may have confounded one case, but the authors proposed that olanzapine was the causative agent.…”

Section: Discussionmentioning

confidence: 99%

“…Seven cases measured and documented acute hypertriglyceridaemia in the context of olanzapine use. [4][5][6][7][8] Plasmapheresis was required and integral to recovery in one patient with a profoundly raised triglyceride level. 4 Authors from gastroenterology recommended that patients be screened and treated for hypertriglyceridaemia prior to starting treatment with olanzapine.…”

Section: Discussionmentioning

confidence: 99%

“…Olanzapine has been observed and documented to be associated with acute pancreatitis. [1][2][3][4][5][6][7][8][9][10] The likelihood of adverse events due to olanzapine is possible on average according to the Naranjo Scale (a validated adverse drug event rating scale). 11 The likely mechanism of action is acute hypertriglyceridaemia.…”

Section: Introductionmentioning

confidence: 99%

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Olanzapine-induced acute necrotising pancreatitis leading to recurrent multiple organ dysfunction syndrome

2022

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A married mother in her 50s acutely developed vomiting, diarrhoea and severe epigastric pain 2 weeks following discharge from an acute psychiatric inpatient unit. She presented to the emergency department complaining of a 2-day history of the above symptoms. Blood tests revealed neutrophilia, grossly raised inflammatory markers and amylase levels triple the normal range. Based on radiological investigations, she was treated for necrotising pancreatitis that quickly escalated to multi-system organ failure and a lengthy intensive care unit admission. Common causes of pancreatitis, including cholelithiasis, alcohol and other drugs, were ruled out. Despite this, she suffered recurrent episodes of pancreatitis with significant morbidity. Olanzapine, started during her psychiatric admission, was determined to be the offending agent. Two years following the discontinuation of olanzapine, the patient has had no further episodes of acute pancreatitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Olanzapine-induced acute necrotising pancreatitis leading to recurrent multiple organ dysfunction syndrome

2022

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“…Acute pancreatitis is one of the rare and serious complications of antipsychotics. Studies reveal that among atypical antipsychotics, olanzapine and clozapine are associated with increased chances of induced pancreatitis, 7 whereas risperidone is the least likely to cause acute pancreatitis. The duration of acute pancreatitis varies, occurring in most patients within 6 months of the initiation or adjustment of their dose of antipsychotic medication.…”

Section: Discussionmentioning

confidence: 99%

Risperidone-induced neuroleptic malignant syndrome: a case report

Deng

Qiu

Wang

2022

Therapeutic Advances in Psychopharmacology

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Neuroleptic malignant syndrome (NMS) is a rare illness that results from reactions to antipsychotics. However, the diagnosis of NMS is challenging due to its atypical clinical presentation and unclear pathogenesis. We report the case of a patient with NMS induced by irregular use of antipsychotics, especially risperidone (RSP). He had typical hyperthermia, muscle rigidity and rhabdomyolysis, which led to renal impairment. We carefully analysed the mechanism by which NMS occurred in this patient. An interesting aspect of the case is the synergistic involvement of risperidone, antidepressants, opioids and stress. Because of these complex predisposing factors, it is difficult to completely rule out the diagnosis of malignant hyperthermia (MH). In addition, the rare phenomenon of elevated lipase and amylase was observed in this patient.

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“…More than 40 case reports have been published on the association between antipsychotic drugs and risk of acute pancreatitis, with the bulk of them detailing the second‐generation (atypical) agents Clozapine and Olanzapine 5–9 . However, data from well‐controlled pharmacoepidemiological studies are sparse and somewhat inconsistent with case report data.…”

Section: Introductionmentioning

confidence: 99%

Antipsychotic drugs and risk of acute pancreatitis: A nationwide case–control study

Sadr–Azodi

Ljung

Lindblad

et al. 2023

Acta Psychiatr Scand

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Introduction: Use of antipsychotic drugs, especially second-generation agents, has been suggested to cause acute pancreatitis in multiple case reports; however, such an association has not been corroborated by larger studies. This study examined the association of antipsychotic drugs with risk of acute pancreatitis.Methods: Nationwide case-control study, based on data from several Swedish registers and including all 52,006 cases of acute pancreatitis diagnosed in Sweden between 2006 and 2019 (with up to 10 controls per case; n = 518,081).Conditional logistic regression models were used to calculate odds ratios (ORs) in current and past users of first-generation and second-generation antipsychotic drugs (dispensed prescription <91 and ≥91 days of the index date, respectively) compared with never users of such drugs.Results: In the crude model, first-generation and second-generation antipsychotic drugs were associated with increased risk of acute pancreatitis, with slightly higher ORs for past use (1.58 [95% confidence interval 1.48-1.69] and 1.39 [1.29-1.49], respectively) than for current use (1.34 [1.21-1.48] and 1 .24 [1.15-1.34], respectively). The ORs were largely attenuated in the multivariable model-which included, among others, alcohol abuse and the Charlson comorbidity index-up to the point where only a statistically significant association remained for past use of first-generation agents ]).Conclusion: There was no clear association between use of antipsychotic drugs and risk of acute pancreatitis in this very large case-control study, indicating that previous case report data are most likely explained by confounding.

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Acute Necrotizing Pancreatitis Associated With Orally Disintegrating Formulation of Olanzapine

Cited by 5 publications

References 9 publications

Olanzapine-induced acute necrotising pancreatitis leading to recurrent multiple organ dysfunction syndrome

Olanzapine-induced acute necrotising pancreatitis leading to recurrent multiple organ dysfunction syndrome

Risperidone-induced neuroleptic malignant syndrome: a case report

Antipsychotic drugs and risk of acute pancreatitis: A nationwide case–control study

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