Losartan-induced Pancreatitis

Abstract

Drug-induced acute pancreatitis (DIAP) is a rare gastrointestinal condition but well-known in the medical literature. The medications have been classified into four subgroups (Classes I-IV) depending upon the propensity of the cases discussed in the literature, interval time period between drug initiation to pancreatitis, and reaction to the drug with reintroduction. Our clinical case is one such example where losartan was described as the agent of recurrent pancreatitis after excluding all other possible causes with laboratory and imaging studies.

Delayed-Onset Losartan-Induced Pancreatitis Secondary to an Overdose: A Case Report

“…Anwar et al, Birck et al, and Bosch all describe cases where DIAP occurred with positive rechallenge and varying lengths of latency: 0 days, 7 days, and 3 days, respectively. 4,7,11 Tripathi et al describe a case with a latency period of 2 days. Similar to our case, the patient was not rechallenged.…”

“…3 The most common causes are cholelithiasis and alcohol use while other causes include hypertriglyceridemia, endoscopic retrograde cholangiopancreatography (ERCP), scorpion bites, and medications such as diuretics and antibiotics. 4,5 Drugs are responsible for about 0.1% to 2% of all acute pancreatitis cases. 2 According to the World Health Organization, 525 different drugs have been described as having an adverse effect of acute pancreatitis, with mesalazine, azathioprine, and simvastatin shown to have the strongest correlation.…”

Lisinopril-Associated Recurrent Hemorrhagic Pancreatitis

“…Other less common causes include hypertriglyceridemia, hypercalcemia, postendoscopic retrograde cholangiography, infection (ie, viruses, bacteria, fungi, parasites), genetic susceptibility, autoimmune cause, ischemia, anatomic or physiologic pancreatic anomalies, and certain medications. [5][6][7][8] Drug-induced acute pancreatitis is not very common, estimated to be less than 5%, which could be very difficult to diagnose. 6 The potential mechanisms involved in drug-induced acute pancreatitis include direct toxic effect accumulation of toxic metabolite immunologic reactions, ischemia, increased viscosity of pancreatic juice, and intravascular thrombosis 5 Drugs implicated with acute pancreatitis include aminosalicylates, sulfonamides, 6-mercaptopurine, valproic acid, diuretics, azathioprine, and estrogen.…”

“…In Kory's publication, 6 ivermectin showed ability to prevent transmission and improvement in the treatment in both observational 9,10 and randomized trials. 7,8,11,12,13 Our work was included in this systematic review. This letter to the editor aims to provide more details of our findings, presenting experimental evidence for the prophylactic use of ivermectin associated with iota-carrageenan in health workers.…”

“…There are case reports of acute pancreatitis with both ACE-I and angiotensin II receptor blockers. 7,8 There seems to be no cross-reactivity. In our case, the patient tolerated the losartan well, which was started in the setting of worsening diabetic nephropathy.…”