REVIEW - Drug-induced pancreatitis

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Best Pract Res Clin Gastroenterol. 2010 Apr;24(2):143-55.

Drug induced pancreatitis.

Nitsche CJ, son N, Lerch MM, Mayerle JV.

Department of Medicine A, Ernst-Moritz-Arndt-University Greifswald,

Friedrich-Loeffler-Strasse 23a, Greifswald 17475, Germany.

Abstract

525 different drugs that can, as an adverse reaction, induce acute

pancreatitis are listed in a WHO database. Compared to other causes

drugs represent a relatively rare cause of pancreatitis. They should

be considered as a triggering event in patients with no other

identifiable cause of the disease, who takes medications that have

been shown to induce pancreatitis. The prevalence of drug-induced

pancreatitis is still unclear because most incidences have been

documented only as isolated case reports. The overall incidence

probably ranges from between 0.1 and 2% of pancreatitis cases. For

only very few substances evidence from controlled trials has been

obtained.

Epidemiologic data suggest the risk of pancreatitis is highest for

mesalazine (HR 3.5,) azathioprine (HR 2,5) and simvastatine (HR 1,8).

Even when a definite association has been demonstrated it is often

impossible to determine whether the drug, or the underlying condition

for which the drug was taken has conferred the risk of pancreatitis

(e.g. azathioprine and Crohns disease or pentamidine and HIV).

Knowledge about the underlying pathophysiologic mechanisms as well as

evidence for a direct causality often remains sparse. For only 31

drugs a definite causality has been established. The most frequently

reported are mesalazine (nine cases in total, three cases with

re-exposure), azathioprine (five cases in total, two cases with

re-exposure) and simvastatin (one case in total, this one with

re-exposure). As cause-effect relationship is generally accepted when

symptoms re-occur upon re-challenge. Available data from case control

studies suggest that even drugs with solid evidence for an association

with pancreatitis only rarely cause the disease. Even when

pancreatitis is induced as an adverse drug event the disease course is

usually mild or even subclinical.

PMID: 20227028

http://www.ncbi.nlm.nih.gov/pubmed/20227028

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