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. 1995 Oct;37(4):565–567. doi: 10.1136/gut.37.4.565

Drug induced acute pancreatitis: incidence and severity.

P G Lankisch 1, M Dröge 1, F Gottesleben 1
PMCID: PMC1382911  PMID: 7489946

Abstract

To determine the incidence and severity of drug induced acute pancreatitis, data from 45 German centres of gastroenterology were evaluated. Among 1613 patients treated for acute pancreatitis in 1993, drug induced acute pancreatitis was diagnosed in 22 patients (incidence 1.4%). Drugs held responsible were azathioprine, mesalazine/sulfasalazine, 2',3'-dideoxyinosine (ddI), oestrogens, frusemide, hydrochlorothiazide, and rifampicin. Pancreatic necrosis not exceeding 33% of the organ was found on ultrasonography or computed tomography, or both, in three patients (14%). Pancreatic pseudocysts did not occur. A decrease of arterial PO2 reflecting respiratory insufficiency, and an increase of serum creatinine, reflecting renal insufficiency as complications of acute pancreatitis were seen in two (9%) and four (18%) patients, respectively. Artificial ventilation was not needed, and dialysis was necessary in only one (5%) case. Two patients (9%) died of AIDS and tuberculosis, respectively; pancreatitis did not seem to have contributed materially to their death. In conclusion, drugs rarely cause acute pancreatitis, and drug induced acute pancreatitis usually runs a benign course.

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Selected References

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  1. Abdullah A. M., Scott R. B., Martin S. R. Acute pancreatitis secondary to 5-aminosalicylic acid in a child with ulcerative colitis. J Pediatr Gastroenterol Nutr. 1993 Nov;17(4):441–444. doi: 10.1097/00005176-199311000-00019. [DOI] [PubMed] [Google Scholar]
  2. Aubry A., Alandry C., Lemiere C. Pancréatite aiguë au cours d'un traitement par salazosulfapyridine. Presse Med. 1989 Jan 21;18(2):80–80. [PubMed] [Google Scholar]
  3. Bale J. F., Jr, Gay P. E., Madsen J. A. Monitoring of serum amylase levels during valproic acid therapy. Ann Neurol. 1982 Feb;11(2):217–218. doi: 10.1002/ana.410110226. [DOI] [PubMed] [Google Scholar]
  4. Bank L., Wright J. P. 6-Mercaptopurine-related pancreatitis in 2 patients with inflammatory bowel disease. Dig Dis Sci. 1984 Apr;29(4):357–359. doi: 10.1007/BF01318523. [DOI] [PubMed] [Google Scholar]
  5. Block M. B., Genant H. K., Kirsner J. B. Pancreatitis as an adverse reaction to salicylazosulfapyridine. N Engl J Med. 1970 Feb 12;282(7):380–382. doi: 10.1056/NEJM197002122820710. [DOI] [PubMed] [Google Scholar]
  6. Bouvet E., Casalino E., Prevost M. H., Vachon F. Fatal case of 2',3'-dideoxyinosine-associated pancreatitis. Lancet. 1990 Dec 15;336(8729):1515–1515. doi: 10.1016/0140-6736(90)93228-h. [DOI] [PubMed] [Google Scholar]
  7. Buchanan N., Cane R. D. Frusemid-induced pancreatitis. Br Med J. 1977 Nov 26;2(6099):1417–1417. doi: 10.1136/bmj.2.6099.1417-c. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Butler K. M., Husson R. N., Balis F. M., Brouwers P., Eddy J., el-Amin D., Gress J., Hawkins M., Jarosinski P., Moss H. Dideoxyinosine in children with symptomatic human immunodeficiency virus infection. N Engl J Med. 1991 Jan 17;324(3):137–144. doi: 10.1056/NEJM199101173240301. [DOI] [PubMed] [Google Scholar]
  9. Call T., Malarkey W. B., Thomas F. B. Acute pancreatitis secondary to furosemide with associated hyperlipidemia. Am J Dig Dis. 1977 Sep;22(9):835–838. doi: 10.1007/BF01694517. [DOI] [PubMed] [Google Scholar]
  10. Chiba M., Horie Y., Ishida H., Arakawa H., Masamune O. A case of salicylazosulfapyridine (Salazopyrin)-induced acute pancreatitis with positive lymphocyte stimulation test (LST). Gastroenterol Jpn. 1987 Apr;22(2):228–233. doi: 10.1007/BF02774222. [DOI] [PubMed] [Google Scholar]
  11. Cooley T. P., Kunches L. M., Saunders C. A., Ritter J. K., Perkins C. J., McLaren C., McCaffrey R. P., Liebman H. A. Once-daily administration of 2',3'-dideoxyinosine (ddI) in patients with the acquired immunodeficiency syndrome or AIDS-related complex. Results of a Phase I trial. N Engl J Med. 1990 May 10;322(19):1340–1345. doi: 10.1056/NEJM199005103221902. [DOI] [PubMed] [Google Scholar]
  12. Davies P., Roberts M. B., Roylance J. Acute reactions to urographic contrast media. Br Med J. 1975 May 24;2(5968):434–437. doi: 10.1136/bmj.2.5968.434. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Delgado Fontaneda E., García Campos F., Ruiz Rebollo L., Ibarra Peña B., Moretó Canela M. Pancreatitis aguda por salazopirina. Una asociación excepcional. Rev Esp Enferm Dig. 1991 Jun;79(6):439–440. [PubMed] [Google Scholar]
  14. Deprez P., Descamps C., Fiasse R. Pancreatitis induced by 5-aminosalicylic acid. Lancet. 1989 Aug 19;2(8660):445–446. doi: 10.1016/s0140-6736(89)90620-x. [DOI] [PubMed] [Google Scholar]
  15. Dobrilla G., Felder M., Chilovi F. Medikamentös induzierte akute Pankreatitis. Schweiz Med Wochenschr. 1985 Jun 22;115(25):850–858. [PubMed] [Google Scholar]
  16. Dobrilla G., Felder M., Chilovi F. Sichere Zusammenhänge zwischen Medikamenten und Pankreatitis. Dtsch Med Wochenschr. 1986 May 30;111(22):868–870. doi: 10.1055/s-2008-1068548. [DOI] [PubMed] [Google Scholar]
  17. Eckardt V. F., Kanzler G., Rieder H., Ewe K. 5-Aminosalicylsäure-assoziierte Pankreatitis. Dtsch Med Wochenschr. 1991 Apr 5;116(14):540–542. doi: 10.1055/s-2008-1063645. [DOI] [PubMed] [Google Scholar]
  18. Eckhauser M. L., Dokler M., Imbembo A. L. Diuretic-associated pancreatitis: a collective review and illustrative cases. Am J Gastroenterol. 1987 Sep;82(9):865–870. [PubMed] [Google Scholar]
  19. Fiorentini M. T., Fracchia M., Galatola G., Barlotta A., de la Pierre M. Acute pancreatitis during oral 5-aminosalicylic acid therapy. Dig Dis Sci. 1990 Sep;35(9):1180–1182. doi: 10.1007/BF01537594. [DOI] [PubMed] [Google Scholar]
  20. Garau P., Orenstein S. R., Neigut D. A., Kocoshis S. A. Pancreatitis associated with olsalazine and sulfasalazine in children with ulcerative colitis. J Pediatr Gastroenterol Nutr. 1994 May;18(4):481–485. doi: 10.1097/00005176-199405000-00015. [DOI] [PubMed] [Google Scholar]
  21. Glueck C. J., Lang J., Hamer T., Tracy T. Severe hypertriglyceridemia and pancreatitis when estrogen replacement therapy is given to hypertriglyceridemic women. J Lab Clin Med. 1994 Jan;123(1):59–64. [PubMed] [Google Scholar]
  22. Glueck C. J., Scheel D., Fishback J., Steiner P. Estrogen-induced pancreatitis in patients with previously covert familial type V hyperlipoproteinemia. Metabolism. 1972 Jul;21(7):657–666. doi: 10.1016/0026-0495(72)90089-3. [DOI] [PubMed] [Google Scholar]
  23. Grimaud J. C., Maillot A., Bremondy A., Thervet L., Salducci J. Faut-il toujours accuser la sulfapyridine? A propos d'un cas de pancréatite aiguë induite par la mésalazine. Gastroenterol Clin Biol. 1989 Apr;13(4):432–432. [PubMed] [Google Scholar]
  24. Guillaume P., Grandjean E., Malè P. J. Azathioprine-associated acute pancreatitis in the course of chronic active hepatitis. Dig Dis Sci. 1984 Jan;29(1):78–79. doi: 10.1007/BF01296866. [DOI] [PubMed] [Google Scholar]
  25. Haber C. J., Meltzer S. J., Present D. H., Korelitz B. I. Nature and course of pancreatitis caused by 6-mercaptopurine in the treatment of inflammatory bowel disease. Gastroenterology. 1986 Oct;91(4):982–986. doi: 10.1016/0016-5085(86)90703-1. [DOI] [PubMed] [Google Scholar]
  26. Isaacs K. L., Murphy D. Pancreatitis after rectal administration of 5-aminosalicylic acid. J Clin Gastroenterol. 1990 Apr;12(2):198–199. doi: 10.1097/00004836-199004000-00019. [DOI] [PubMed] [Google Scholar]
  27. Isenberg J. N. Pancreatitis, amylase clearance, and azathioprine. J Pediatr. 1978 Dec;93(6):1043–1044. doi: 10.1016/s0022-3476(78)81256-6. [DOI] [PubMed] [Google Scholar]
  28. Jones P. E., Oelbaum M. H. Frusemide-induced pancreatitis. Br Med J. 1975 Jan 18;1(5950):133–134. doi: 10.1136/bmj.1.5950.133. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Kawanishi H., Rudolph E., Bull F. E. Azathioprine-induced acute pancreatitis. N Engl J Med. 1973 Aug 16;289(7):357–357. doi: 10.1056/NEJM197308162890708. [DOI] [PubMed] [Google Scholar]
  30. Kristensen B. O., Skov J., Peterslund N. A. Frusemide-induced increases in serum isoamylases. Br Med J. 1980 Oct 11;281(6246):978–978. doi: 10.1136/bmj.281.6246.978. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Lambert J. S., Seidlin M., Reichman R. C., Plank C. S., Laverty M., Morse G. D., Knupp C., McLaren C., Pettinelli C., Valentine F. T. 2',3'-dideoxyinosine (ddI) in patients with the acquired immunodeficiency syndrome or AIDS-related complex. A phase I trial. N Engl J Med. 1990 May 10;322(19):1333–1340. doi: 10.1056/NEJM199005103221901. [DOI] [PubMed] [Google Scholar]
  32. Mallory A., Kern F. Drug-induced pancreatitis. Baillieres Clin Gastroenterol. 1988 Apr;2(2):293–307. doi: 10.1016/0950-3528(88)90005-x. [DOI] [PubMed] [Google Scholar]
  33. Mallory A., Kern F., Jr Drug-induced pancreatitis: a critical review. Gastroenterology. 1980 Apr;78(4):813–820. [PubMed] [Google Scholar]
  34. Maxson C. J., Greenfield S. M., Turner J. L. Acute pancreatitis as a common complication of 2',3'-dideoxyinosine therapy in the acquired immunodeficiency syndrome. Am J Gastroenterol. 1992 Jun;87(6):708–713. [PubMed] [Google Scholar]
  35. Moyle G. J., Nelson M. R., Hawkins D., Gazzard B. G. The use and toxicity of didanosine (ddI) in HIV antibody-positive individuals intolerant to zidovudine (AZT) Q J Med. 1993 Mar;86(3):155–163. [PubMed] [Google Scholar]
  36. Nguyen D. L., Wilson D. A., Engelman E. D., Sexauer C. L., Nitschke R. Serial sonograms to detect pancreatitis in children receiving L-asparaginase. South Med J. 1987 Sep;80(9):1133–1136. doi: 10.1097/00007611-198708090-00015. [DOI] [PubMed] [Google Scholar]
  37. Nogueira J. R., Freedman M. A. Acute pancreatitis as a complication of Imuran therapy in regional enteritis. Gastroenterology. 1972 May;62(5):1040–1041. [PubMed] [Google Scholar]
  38. Paloyan D., Levin B., Simonowitz D. Azathioprine-associated acute pancreatitis. Am J Dig Dis. 1977 Sep;22(9):839–840. doi: 10.1007/BF01694518. [DOI] [PubMed] [Google Scholar]
  39. Poldermans D., van Blankenstein M. Pancreatitis induced by disodium azodisalicylate. Am J Gastroenterol. 1988 May;83(5):578–580. [PubMed] [Google Scholar]
  40. Roblin X., Becot F., Jacquot J. M., Nairi A., Abinader J., Monnet D. Pancréatite aiguë sous azathioprine. Ann Gastroenterol Hepatol (Paris) 1990 Oct;26(5):233–233. [PubMed] [Google Scholar]
  41. Romero Castro R., Jiménez Sáenz M., Pellicer Bautista F. J., Domínguez Palomo S., Herrerías Gutiérrez J. M. Pancreatitis aguda por ácido 5-aminosalicílico. Rev Esp Enferm Dig. 1991 Mar;79(3):219–221. [PubMed] [Google Scholar]
  42. Sachedina B., Saibil F., Cohen L. B., Whittey J. Acute pancreatitis due to 5-aminosalicylate. Ann Intern Med. 1989 Mar 15;110(6):490–492. doi: 10.7326/0003-4819-110-6-490. [DOI] [PubMed] [Google Scholar]
  43. Seidlin M., Lambert J. S., Dolin R., Valentine F. T. Pancreatitis and pancreatic dysfunction in patients taking dideoxyinosine. AIDS. 1992 Aug;6(8):831–835. doi: 10.1097/00002030-199208000-00011. [DOI] [PubMed] [Google Scholar]
  44. Stenvinkel P., Alvestrand A. Loop diuretic-induced pancreatitis with rechallenge in a patient with malignant hypertension and renal insufficiency. Acta Med Scand. 1988;224(1):89–91. doi: 10.1111/j.0954-6820.1988.tb16743.x. [DOI] [PubMed] [Google Scholar]
  45. Sturdevant R. A., Singleton J. W., Deren J. L., Law D. H., McCleery J. L. Azathioprine-related pancreatitis in patients with Crohn's disease. Gastroenterology. 1979 Oct;77(4 Pt 2):883–886. [PubMed] [Google Scholar]
  46. Taft P. M., Jones A. C., Collins G. M., Halasz N. A. Acute pancreatitis following renal allotransplantation. A lethal complication. Am J Dig Dis. 1978 Jun;23(6):541–544. doi: 10.1007/BF01072698. [DOI] [PubMed] [Google Scholar]
  47. Tran K., Froguel E., Jian R., Lemann M., Modigliani R. Acute pancreatitis induced by mesalazine. J Clin Gastroenterol. 1991 Dec;13(6):715–716. doi: 10.1097/00004836-199112000-00021. [DOI] [PubMed] [Google Scholar]
  48. Unreviewed reports. Br Med J (Clin Res Ed) 1986 Mar 15;292(6522):732–732. [PMC free article] [PubMed] [Google Scholar]
  49. Wilson A. E., Mehra S. K., Gomersall C. R., Davies D. M. Acute pancreatitis associated with frusemide therapy. Lancet. 1967 Jan 14;1(7481):105–105. doi: 10.1016/s0140-6736(67)92499-3. [DOI] [PubMed] [Google Scholar]
  50. Yarchoan R., Pluda J. M., Thomas R. V., Mitsuya H., Brouwers P., Wyvill K. M., Hartman N., Johns D. G., Broder S. Long-term toxicity/activity profile of 2',3'-dideoxyinosine in AIDS or AIDS-related complex. Lancet. 1990 Sep 1;336(8714):526–529. doi: 10.1016/0140-6736(90)92085-v. [DOI] [PubMed] [Google Scholar]
  51. ZION M. M., GOLDBERG B., SUZMAN M. M. Corticotrophin and cortisone in the treatment of scleroderma. Q J Med. 1955 Jul;24(95):215–227. [PubMed] [Google Scholar]

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