Linagliptin-Induced Pancreatitis

Abstract

Objective: To report a case of linagliptin-induced acute pancreatitis and remind clinicians about risks with incretin-based drugs. Patients at risk for pancreatitis should be switched to another type of hypoglycemic treatment. Methods: We present the case of a 74-year-old Latina who presented to the emergency department with sudden onset of epigastric pain radiating to her back. Medical history, physical exam, laboratory tests, and medical images were compatible with acute pancreatitis. Upon further investigation, common causes for her pathology were excluded. Ten weeks prior to presentation she had changed her medications for diabetes mellitus type 2 to linagliptin. Results: Using the Naranjo algorithm of adverse drug reactions, we concluded that linagliptin was the most likely culprit. Conclusion: Incretin-based drugs, including dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists, have been shown to be relatively safe for the management of type 2 diabetes mellitus. Since their introduction to the market, conflicting data regarding pancreatic side effects have been published, including a small risk of developing acute pancreatitis with dipeptidyl peptidase-4 inhibitors like sitagliptin and saxagliptin. To date there has been only 1 case report associating linagliptin with acute pancreatitis in the English medical literature. Ours is the first case report in the United States associating linagliptin with acute pancreatitis. It is worth warning both patients and prescribers about this serious adverse effect, as it might affect the choice of antiglycemic agent.

Mild Pancreatitis Induced by Linagliptin Revealed by a Medication Review

“…On initial follow-up after the acute emergency department visit, the patient had persistent symptoms, which prompted the search for other etiologies of pancreatitis. After reviewing all the medications the patient was taking, atorvastatin, lisinopril, and linagliptin were noted to be the three potential medications that could cause pancreatitis [2][3][4][7][8]. Although atorvastatin-induced pancreatitis can happen at any time, it was more common a few months after initiation [8].…”

“…The mechanism is unknown. There have been case reports describing pancreatitis caused by DPP-4 inhibitors [2][3][4]. Pancreatitis caused by DPP-4 inhibitors may be as rare as one in 1,000 cases, as reported by the government of the United Kingdom [5].…”

Acute Pancreatitis Induced by Linagliptin: A Rare but Dangerous Side Effect

“…A proposed mechanism of pancreatic injury by DPP-4 inhibitors is the increase of the half-life of GLP-1, which causes ductal hyperplasia in the pancreas with subsequent outflow obstruction and intrapancreatic activation of enzymes, leading to a state of chronic inflammation [ 5 ]. To the best of our knowledge, there have been only two case reports of linagliptin-induced pancreatitis so far and several reports for other DPP-4 inhibitors [ 6 , 7 ]. We believe that it is essential for clinicians to remember the possibility of developing acute pancreatitis in patients using DPP-4 inhibitors.…”

Escitalopram-induced sinus bradycardia in coronary heart disease combined with depression: a case report and review of literature

“…The levels of cardiac troponin I (0.007 μg/L) and B natriuretic peptide (45.1 pg/ml) were also in the normal range. The patient obtained a Naranjo's Algorithm ADR probability score of 7, which is used to assess whether there is a causal relationship between an adverse drug experience and a drug, using a simple questionnaire to assign probability scores ( 5 ). If the total Naranjo's Algorithm score lies between 5 and 8, the causal relationship is “highly possible”; if the total score is greater than or equal to 9, the causal relationship is “definite”.…”