Acute Pancreatitis as a Complication of Antiepileptic Treatment: Case Series and Review of the Literature

Pawłowska-Kamieniak, Agnieszka; Krawiec, Paulina; Pac-Kożuchowska, Elżbieta

doi:10.3390/pediatric13010014

Cited by 6 publications

(3 citation statements)

References 16 publications

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“…La necrosis 96-99 aguda es un hallazgo raro en pacientes con pancreatitis aguda, y se debe a la liberación de diferentes mediadores y citoquinas proinflamatorias que llevan a falla multiorgánica. Este hallazgo es más común en adultos que en niños 14 .…”

Section: Discussionunclassified

Pancreatitis inducida por ácido valproico: reporte de caso

Gallego¹,

Mejía

2023

MedUPB

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La pancreatitis en pediatría se consideraba anteriormente una enfermedad poco frecuente; en la actualidad se reportan 13.2 casos por 100 000 niños/año. La causa más importante de pancreatitis en la población pediátrica, después de la etiología biliar, son los medicamentos (13% de los casos). Uno de los principales medicamentos como causa de pancreatitis en pediatría es el ácido valproico (AV); el cual puede inducir una pancreatitis aguda. Aquí se presentará el primer caso de pancreatitis por AV en población pediátrica reportado en Colombia. Se trata de un paciente de cuatro años, con trastorno en el neurodesarrollo por un síndrome de TORCH, quien tomaba AV a largo plazo por un trastorno de la conducta. Ingresó a una institución de alta complejidad donde se diagnostica pancreatitis aguda con signos de necrosis en tejido pancreático secundario a uso de AV. Se suspendió el medicamento con resolución de su cuadro clínico y alta médica hacia el día 15

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Section: Discussionunclassified

Pancreatitis inducida por ácido valproico: reporte de caso

Gallego¹,

Mejía

2023

MedUPB

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“…Despite its effectiveness, its administration is associated with serious complications. The pancreas is a target organ that is affected by valproic acid administration leading to pancreatitis [34,35] . Recently, several studies reported the health protective values of the marjoram oil due to its antioxidant activities [36,37] .…”

Section: Discussionmentioning

confidence: 99%

Marjoram Oil Attenuates Valproic Acid-Induced Pancreatic Damage in Adult Male Albino Rats: A Histological and Immunohistochemical Study

Kassab

Eldin

Abd-El-Hafez

2022

Egyptian Journal of Histology

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Introduction:Valproic acid [VA] is an antiepileptic drug that is extensively prescribed for many neurological disorders. Its use is associated with serious pancreatic complications. Marjoram oil [MO] is a health protective agent with proved anti-oxidant activity. Aim: Study of the effect of valproic acid on pancreas of adult male albino rats exploring novel mechanisms of VA-induced pancreatic damage and to evaluate the potential protective role of marjoram oil. Materials and Methods: Fifty adult male albino rats were used as a control group, a valproic acid group and a valproic acidmarjoram group. Both VA [200mg/kg] and MO [0.5ml/kg] were given once a day orally for eight weeks. Specimens of the pancreas were processed for light and electron microscopic studies. Immunohistochemical study was performed using anti-P53 antibodies.Results: Specimens of the valproic acid group showed an obvious distortion in the pancreatic acini as well as the islets of Langerhans. The acinar and islets cells showed cytoplasmic vacuoles and pyknotic nuclei. Large autophagic vacuoles containing an acidophilic material appeared in many cells. Dilated ducts and blood vessels were seen. There was a significant increase in the P53-immunoreaction of the acinar and islets cells and a significant decrease in the number of the zymogen granules of the acinar cells. Ultrastructurally, there were shrunken nuclei with irregularity, dilated rough endoplasmic reticulum and swollen mitochondria in the acinar cells and beta cells. In contrast, minimal changes occurred in the valproic acid-marjoram group that received MO before VA. Conclusion: Valproic acid administration to albino rats resulted in significant structural alterations in the pancreas. Marjoram oil attenuated VA effect and preserved the pancreas structure.

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“…50 Valproate-induced pancreatitis has been extensively reviewed multiple times throughout current literature. [50][51][52][53][54]…”

Section: Pancreatitismentioning

confidence: 99%

Valproate: Not All Boxed Warnings Are Created Equal

Wartman

VandenBerg

2022

Ann Pharmacother

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Objective Valproate has undergone significant changes in labeling to the boxed warnings associated with it. This review will analyze evidence regarding the valproate-boxed warnings for teratogenicity, hepatotoxicity, and pancreatitis, with a particular emphasis on the fetal risk. Data Sources A review of Pubmed, Cochrane Central Register, Google Scholar, manufacturer websites, and product labeling was performed from 1963 to February 2022, using the following search terms: valproate, valproic acid, depakote, teratogenicity, birth defects, fetal risk, hepatotoxicity, and pancreatitis. Relevant English-language studies and those conduced in humans were considered. Product labeling was also reviewed. Data Synthesis There is a significant fetal risk following in utero valproate exposure (risk of malformation development: 8.6% in 360 women in North America). Current labeling in the United States recommends co-prescribing effective contraception for women of childbearing age. The risk of hepatotoxicity and pancreatitis is much lower in the general population (1/20 000 and 1/40 000 patients, respectively) compared with those patients with certain risk factors who are taking valproate (1/500). Conclusions Overstated monitoring recommendations for the potential risk of hepatotoxicity and pancreatitis distracts from a much more common and severe risk of fetal harm. Clinicians must be diligent about discussing this risk with patients and documenting when this discussion occurs. Changes to the current recommendations for monitoring of the boxed warnings associated with valproate therapy should be considered, such as more stringent monitoring requirements for the inherent fetal risk. This could be accomplished through a Risk Evaluation and Mitigation Strategy program or through institution-based policies and procedures. In addition, monitoring recommendations for the risk of hepatotoxicity and pancreatitis should account for contributing risk factors.

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Acute Pancreatitis as a Complication of Antiepileptic Treatment: Case Series and Review of the Literature

Cited by 6 publications

References 16 publications

Pancreatitis inducida por ácido valproico: reporte de caso

Pancreatitis inducida por ácido valproico: reporte de caso

Marjoram Oil Attenuates Valproic Acid-Induced Pancreatic Damage in Adult Male Albino Rats: A Histological and Immunohistochemical Study

Valproate: Not All Boxed Warnings Are Created Equal

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