Drug-Induced Pancreatitis

Abstract

Drugs are a relatively rare cause of acute pancreatitis, with an estimated incidence of 0.1-2%. Many drugs have been suspected of causing pancreatitis, but the true incidence is not known as the evidence is derived mainly from random case reports. Case reports with the strongest evidence are those that clearly diagnose pancreatitis and exclude common aetiologies, provide the dose and time interval between the start of treatment with the suspected drug and the development of pancreatitis, document response to withdrawal of the drug, and demonstrate recurrent pancreatitis upon rechallenge with the drug. Few data exist on the mechanisms of drug-induced pancreatitis. Certain subpopulations such as children, women, the elderly and patients with advanced HIV infection or inflammatory bowel disease may be at higher risk. The diagnosis of drug-induced pancreatitis is often challenging because there are no unique clinical characteristics to distinguish drugs from other causes of pancreatitis. The majority of cases are mild, but severe and even fatal cases may occur, thus making identification of the offending agent critical. Management of drug-induced acute pancreatitis requires withdrawal of the offending agent and supportive care. Prevention of drug-induced pancreatitis requires an up-to-date knowledge of drugs that have the strongest evidence linking their use to the development of pancreatitis as well as the proposed mechanisms through which they may cause the reaction. In this paper, the epidemiology, diagnosis, management and prevention of drug-induced pancreatitis is reviewed. Drugs and classes of drugs strongly implicated as causing acute pancreatitis, based on well documented case reports, are discussed in detail.

Acute Abdominal Pain in Patients with Systemic Lupus Erythematosus

“…26 The incidence of drug induced pancreatitis in the general population is 0.1-2%. 27 This is much lower of what we observed in our study. However, one the reasons that could explain this is that most of the individuals included in our study are taking at least one of the drugs associated with this condition.…”

Tigecycline-induced acute pancreatitis: case report and literature review

“…Other aetiologies include idiopathic pancreatitis, post-endoscopic retrograde cholangiopancreatography, trauma, medications, infection, hypercalcaemia, hypertriglyceridaemia, tumour and autoimmune diseases [5]. Several medications have been linked to acute pancreatitis and the overall incidence of drug-induced acute pancreatitis is 0.1-2% [5].…”

“…No other common causes of acute pancreatitis, such as trauma, alcoholism or TPN use, were identified. Famotidine was the only other medication in her regimen that could possibly induce acute pancreatitis [5], but she had been on famotidine for many years and symptoms and laboratory abnormalities resolved despite continuation of this medication. It is therefore unlikely that famotidine induced the acute pancreatitis.…”

Acute pancreatitis induced by etoposide–lobaplatin combination chemotherapy used for the treatment of lung cancer

“…Approximately 2% of the cases of AP in adults are drug-induced, [14,15] and most cases of AP are mild or moderate with good prognosis. [16] On the basis of the degree of correlation between drug use and induction of pancreatitis, drugs can be classified into 3 categories: definitively correlated, probably correlated, or possibly correlated.…”