Acute pancreatitis has a high morbidity and significant mortality. Among its many causes ethanol is pre-eminent, but many other drugs have also been incriminated. This article begins with a definition of the mechanisms, pathogenesis and clinical features of acute pancreatitis; it then critically reviews the evidence for drugs, excluding ethanol, as being causative. The drugs which have been implicated are considered under 3 headings: definite associations, probable associations and unlikely associations. A brief outline of possible treatment, strategies and prognosis associated with acute pancreatitis concludes the article.