Muscle relaxant induced pancreatitis leading to hyperosmolar hyperglycemic state

Abstract

Muscle relaxants are commonly prescribed in the United States but may have deleterious side effects that are unrecognized by physicians. Here, we report a 55-year-old Caucasian man who developed pancreatitis and a subsequent hyperosmolar hyperglycemic state after being prescribed tizanidine. The patient had untreated hypertriglyceridemia, unbeknownst to the prescribing physician. While hypertriglyceridemia is a widely understood risk factor for pancreatitis, its incidence with tizanidine is not. As an alpha-2 agonist, tizanidine slows gastrointestinal motility by inhibiting gastrointestinal smooth muscle contraction, which could lead to ileus which occurred in this patient. Alpha-2 agonists further contract the hepato-pancreatic sphincter, which may result in obstruction of pancreatic enzyme flow via the pancreatic duct. This patient’s case of pancreatitis was precipitated by 2 factors: (i) his use of tizanidine and (ii) hypertriglyceridemia. This case demonstrates that patients presenting with severe hypertriglyceridemia, or other potential risk factors for pancreatitis, should not be prescribed tizanidine.

Necrotizing pancreatitis, microangiopathic hemolytic anemia and thrombocytopenia following the second dose of Pfizer/BioNTech COVID-19 mRNA vaccine

“…In addition, many drugs are reported to induce pancreatic damage [ 15 ]; however, pancreatitis associated with intake of tizanidine. zolpidem and mirtazapine occurred either shortly after initiation of the drugs [ 16 ] or with concomitant precipitating disorders, such as alcohol abuse or hypertriglyceridemia [ 17 , 18 ]. In the presented patient, drug-induced pancreatitis is rather unlikely as the chronic medication was unchanged during the 6 months prior to admission and neither hypertriglyceridemia nor alcohol abuse was present.…”

Drug-Induced Acute Pancreatitis - Literature Overview and Our Experience

“…V našem souboru se jednalo o první popsanou kazuistiku těžké pankreatitidy s multiorgánovým selháním a úmrtím pacientky (12,24). Svalové relaxans tizanidin jako příčina akutní pankreatitidy byl zatím popsán pouze kazuisticky (25). Cefuroximem indukovaná akutní pankreatitida zatím v literatuře popsána nebyla, vzhledem k časové souvislosti s podáním léku a vyloučením jiné etiologie onemocnění byla tato kazuistika námi publikována (26).…”