ReviewDrug-Induced Acute Pancreatitis: An Evidence-Based Review
Section snippets
Identification and Classification of Drugs
A MEDLINE search (1955–2006) of the English language literature for all cases with acute pancreatitis revealed 1214 case reports that allowed classification of 120 drugs. Search terms included “pancreatitis” and “drug-induced” or “medication-induced,” “drug,” and “medication.” The search was confined to human studies. Relevant bibliographies were included. The latest search date was July 1, 2006. Pharmaceutical and Food and Drug Administration data were not used for this analysis.
All published
Results
Based on our analysis of the level of evidence, 4 classes of drugs could be identified (Table 1). Class I drugs includes medications in which at least 1 case report described a recurrence of acute pancreatitis with a rechallenge with the drug. Class I drugs were subdivided further into class Ia and class Ib. Class Ia drugs are the drugs in which all potential causes of acute pancreatitis such as gallstones, hypertriglyceridemia, alcohol, hypercalcemia, and other medications were ruled out as a
Discussion
Although uncommon, defining a drug as causing acute pancreatitis poses a challenge to clinicians. To provide an evidence-based review of the literature, we chose to analyze this area by studying the patterns of drug-induced injury in published case reports. These reports allow the critical analysis of published information provided by the physician investigators and the editors of the journal. We did not use data from pharmaceutical or Food and Drug Administration reports because, in general,
Conclusions
We have classified 120 drugs that have been implicated in the scientific literature as causing pancreatitis (Table 2). The drugs are categorized based on the weight of evidence favoring this association. Two pieces of evidence link certain drugs to acute pancreatitis; recurrence of pancreatitis with rechallenge (class I drug) and a consistent latency between ingestion of the drug and the development of pancreatitis (class II drug). The evidence linking the remainder of the drugs to pancreatitis
References (320)
- et al.
Drug associated acute pancreatitis: twenty-one years of spontaneous reporting in the Netherlands
Am J Gastroenterol
(1999) - et al.
Drug-induced pancreatitis: a critical review
Gastroenterology
(1980) - et al.
Acute pancreatitis during treatment with amiodarone
Lancet
(1997) - et al.
Relapsing acute pancreatitis induced by re-exposure to the cholesterol lowering agent bezafibrate
Am J Gastroenterol
(1999) - et al.
Clomiphene-induced severe hypertriglyceridemia and pancreatitis
Mayo Clin Proc
(1999) - et al.
A new source of drug-induced acute pancreatitis: codeine
Am J Gastroenterol
(2000) - et al.
Pancreatitis during therapy of acute myeloid leukemia: cytarabine related?
Ann Oncol
(1999) - et al.
Enalapril-induced acute recurrent pancreatitis
Dig Liver Dis
(2003) - et al.
Acute pancreatitis induced by isoniazid in the treatment of tuberculosis
Am J Gastroenterol
(2001) - et al.
Recurrent acute pancreatitis induced by isoniazid
Tuber Lung Dis
(1994)