A Fatal Case of Lisinopril-Induced Acute Necrotizing Pancreatitis

Abstract

Angiotensin-converting enzyme inhibitors (ACE-I), such as lisinopril, are used as first-line therapy in the treatment of hypertension, heart failure with reduced ejection fraction, and proteinuric chronic kidney disease due to their beneficial effects on reducing morbidity and mortality. Commonly cited adverse effects of lisinopril include hyperkalemia, acute kidney injury, and angioedema, and while uncommon, there have been reports of lisinopril-induced necrotizing pancreatitis in the literature. The true incidence of drug-induced pancreatitis is unknown since establishing a causal relationship between medication’s adverse effects and disease occurrence is difficult; however, there are validated tools such as the Adverse Drug Reaction Probability Scale that can aid in determining causality. Here, we present a case of a 63-year-old man with a history of hypertension who was being treated with lisinopril for eight months and developed a fatal case of lisinopril-induced severe necrotizing pancreatitis.

Risk factors for drug-related acute pancreatitis: an analysis of the FDA adverse event reporting system (FAERS)

“…Ramipril and Lisinopril are angiotensin-converting enzyme inhibitors (ACEIs). There have been many previous reports of ACEIs induced AP (Gershon and Olshaker, 1998;Masarweh et al, 2023), and the mechanism may be related to localized angioedema in the pancreatic ducts (Griesbacher, 2000;Eland et al, 2006). ACEIs decreased the degradation of bradykinin (bradykinin is associated with the development of angioedema).…”