Celecoxib-Induced Acute Pancreatitis and Hepatitis: A Case Report

Metformin-induced lactic acidosis and acute pancreatitis precipitated by diuretic, celecoxib, and candesartan-associated acute kidney dysfunction

“…She was on a thiazide diuretic, which has been implicated as a cause of druginduced acute pancreatitis (10); however, she had been on this drug for many years without this complication. Celecoxib has also been reported to cause acute pancreatitis (11)(12)(13)(14). However, our patient had been on celecoxib without acquiring this problem for two months, and the cyclo-oxygenase 2 inhibitors are felt to pose a low risk for pancreatitis (12).…”

Antiinflamatórios não esteróides inibidores da ciclooxigenase-2 (COX-2): aspectos atuais

“…Em uma revisão de casos clínicos envolvendo 7400 pacientes, ocorreu disfunção hepática em 0,8% daqueles tratados com celecoxib comparados com 0,9% dos tratados com placebo e 3,7% dos que usaram diclofenaco de sódio 44 . Recentes relatos de casos mostraram que o celecoxib foi associado ao desenvolvimento de hepatite e pancreatite 43,45 . Uma explicação possível para tal associação é a presença de sulfonamida na estrutura química do celecoxib, o que desencadearia reação de natureza alérgica, devendo ser evitado em indivíduos intolerantes à sulfa 43 .…”

“…No entanto, ainda persistem dúvidas sobre a possibilidade de reação cruzada entre celecoxib e outras medicações sulfonamidas (ex: antibióticos), já que o radical sulfa deste inibidor COX-2 não possui estrutura amina aromática, a principal envolvida com reações alérgicas adversas 46 . A patogênese da pancreatite associada a AINES pode ser explicada também com base em experimentos animais, os quais sugerem um papel protetor das prostaglandinas nas células pancreáticas 45 .…”

“…In a review of clinical cases involving 7400 patients, liver dysfunction was present in 0.8% of those treated with celecoxib, as compared to 0.9% of those treated with placebo and 3.7% of those treated with sodium diclofenac 44 . Recent case reports have shown that celecoxib was associated to hepatitis and pancreatitis 43,45 . A possible explanation for such association would be the presence of sulfonamide in celecoxib's chemical stucture, which would trigger an allergic reaction and should be avoided by individuals intolerant to sulfa 43 .…”

“…: antibiotics), since the sulfa radical of this COX-2 inhibitor does not have aromatic amine structure, primarily involved in adverse allergic reactions 46 . NSAIDs-induced pancreatitis may also be explained by animal studies which suggest a protecting role of prostaglandins in pancreatic cells 45 .…”