Drug-Induced Pancreatitis

Abstract

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.

Pancreatitis, complicated by a pancreatic pseudocyst associated with the use of valproic acid

“…The development of pancreatitis has been related to more than 55 different drugs. [9][10][11][12] VPA definitely has been associated with pancreatitis, based upon a series of well documented cases. 1 VPA-induced pancreatitis occurs most frequently under the age of 20 and nearly half of the cases present within the first three months after initiation of treatment, though pancreatitis can also develop after years of treatment.…”

Acute pancreatitis complicating anterior lumbar interbody fusion

“…The responsible drugs have been categorized based on definite, probable, and possible causality. A careful review of all drugs received by our patient during her hospitalization revealed three incriminating medications: enalapril, nonsteroidal anti-inflammatory drugs (NSAIDs), and furosemide, the former two in the probable and the latter in the possible causality category [16]. However, unlike all reported cases of enalapril-related pancreatitis, our patient had been continually on this medication for several years [16].…”

“…Drugs have long been regarded as an important cause of pancre- atitis. However, this traditional view has been questioned [12] and the true incidence of drug induced pancreatitis is estimated to be between 1 and 2% [7,16]. The responsible drugs have been categorized based on definite, probable, and possible causality.…”

Acute Pancreatitis Related to Therapeutic Dosing With Colchicine: A Case Report.

“…In 20% of cases, the cause remains unidentified [8]. Drugs are implicated in only 2-5% of cases, either by a hypersensitivity reaction or the generation of a toxic metabolite [14], although it is frequently difficult to prove causality [9].…”