Pancreatitis Due to Valproic Acid

Sasaki, Masakazu; Tonoda, Shigehiko; Aoki, Yozo; Katsumi, Masaharu

doi:10.1016/s0140-6736(80)91660-8

Cited by 36 publications

(17 citation statements)

References 1 publication

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“…[26][27][28][29][30][31][32][33][34][35][36][37][38][39] One patient developed abdominal pain while receiving sulfasalazine for ulcerative colitis and, 2 years later, experienced clinical pancreatitis during therapy with sulfamethoxazole; this patient also had a positive lymphocyte stimulation test with sulphonamides, but not with aminosalicylates. !s3] Lymphocyte stimulation tests indicate a hypersensitivity reaction.…”

Section: Valproic Acid (Sodium Valproate)mentioning

confidence: 99%

Drug-Induced Pancreatitis

1996

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Few data exist about the incidence of drug-induced pancreatitis in the general population. 20 cases of drug-related pancreatitis were reported in Switzerland over a period of 12 years. The proportion of cases of pancreatitis caused by drugs is estimated to be around 2% in the general population, with much higher proportions in specific subpopulations, such as children and patients who are HIV positive. The literature about drug-induced pancreatitis consists mainly of anecdotal case reports. Clear evidence of a definite association with pancreatitis, by means of rechallenge tests, or consistent case reports, supported by animal experiments or data on the incidence of acute pancreatitis in drug trials exists for didanosine, valproic acid (sodium valproate), aminosalicylates, estrogen, calcium, anticholinesterases and sodium stibogluconate. An association with drug-induced pancreatitis is likely but not definitely proven for thiazide diuretics, pentamidine, ACE inhibitors, asparaginase, vinca alkaloids, some nonsteroidal anti-inflammatory drugs and clozapine. Pancreatitis is possibly caused by azathioprine, furosemide (frusemide), tetracycline, metronidazole, isoniazid, rifampicin (rifampin), sulphonamides, cyclosporin and some antineoplastic drugs. Many drugs have been reported to be associated with acute pancreatitis. However, lack of rechallenge evidence, consistent statistical data, or evidence from experimental studies on a possible mechanism prohibit definitive conclusions about most of them. The high incidence of concurrent illnesses known to induce acute pancreatitis, makes a trigger role or co-factor role for the drug seem most likely.

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Section: Valproic Acid (Sodium Valproate)mentioning

confidence: 99%

Drug-Induced Pancreatitis

1996

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“…Thirteen of the 14 patients had hyperamylasemia, and the remaining patient had elevated se¬ rum lipase levels and hemorrhagic ne¬ crosis of the pancreas at laparotomy. All had no history or laboratory evi¬ dence of (1) trauma, (2) hereditary pancreatitis, (3) previous episodes of pancreatitis, (4) hypercholesterolemia, (5) hypercalcemia, (6) recent viral infection, (7) cholelithiasis, (8) alco¬ holism, (9) cystic fibrosis, (10) pan¬ creas divisum, and (11) ingestion of other drugs known to cause pan¬ creatitis.…”

mentioning

confidence: 99%

Pancreatitis Associated With Valproic Acid Therapy

Wyllie

Cruse

Erenberg

et al. 1984

Arch Pediatr Adolesc Med

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“…Pancreatitis in children is still most often due to blunt abdominal trauma, with the leading cause of this trauma being motor vehicle 482 D. Mileusnic et al accidents. Other traumatic events include battered child syndrome and operative injury [21]. In this patient, motor vehicle accident and operative trauma were ruled out early on in investigation, hence our ¢rst thought at the time of autopsy was that the child might have been beaten and su¡ered a blow to the abdomen.…”

Section: Discussionmentioning

confidence: 96%

“…There is general acceptance that the onset of abdominal pain and vomiting in a patient taking valproic acid portends serious problems [10]. Resolution of symptoms on its withdrawal and a recurrence of pancreatitis on re-exposure implicate valproic acid as an important factor in the pathogenesis of pancreatitis [21]. The mean duration of therapy before development of pancreatitis usually ranges from 1to 6 months and the dosage varies widely [2].…”

Section: Discussionmentioning

confidence: 99%

Pathological Case of the Month: Sudden Death in a Child as a Result of Pancreatitis During Valproic Acid Therapy

Mileusnic

Donoghue

Lifschultz

2002

Pediatric Pathology & Molecular Medicine

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Valproic acid is a widely used drug in the treatment of epilepsy and, compared to other anticonvulsant drugs, is considered safe. The most common side effects of valproic acid ingestion or therapy are transient nausea, vomiting, abdominal cramps, and diarrhea. Most of these complaints are mild. However, more serious adverse reactions can occur such as hepatotoxicity and pancreatitis. It has been proposed that, whenever possible, valproic acid not be used in the younger child, the child with a severe seizure disorder or other neurological disorders, mental retardation, developmental delay, organic brain disease, congenital abnormalities, or the child who is taking multiple anticonvulsant drugs, as these factors may increase the likelihood of hepatotoxicity and/or pancreatitis. In the present report, we describe a fatal case of acute hemorrhagic pancreatitis in a four and a half-year-old Hispanic female child who was receiving valproic acid in combination with another anticonvulsant drug for control of focal seizures. The patient also received the macrolide antibiotic azithromycin. For pediatricians and forensic pathologists valproic acid-induced pancreatitis can be a challenging diagnosis which must not be mistaken for abdominal trauma. We discuss the workup of the patient and differential diagnosis.

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Pancreatitis Due to Valproic Acid

Cited by 36 publications

References 1 publication

Drug-Induced Pancreatitis

Drug-Induced Pancreatitis

Pancreatitis Associated With Valproic Acid Therapy

Pathological Case of the Month: Sudden Death in a Child as a Result of Pancreatitis During Valproic Acid Therapy

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