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ADRAC: drug-induced pancreatitis


Gallstones and alcohol are the two most common causes of pancreatitis, but medicines are estimated to account for about 2 to 5% of cases.
ADRAC ( Adverse Drug Reactions Advisory Committee ) has received 414 such reports, implicating 695 medicines. Time to onset varied from the first day of use to many months and, in some cases, several years. Specific information about alcohol use was not provided in most of the reports. Fatal outcomes were documented in 10 of the 414 reports in this series.

Reports of pancreatitis are most frequent with Azathioprine, Didanosine and Valproate.
The drug groups more commonly implicated include antiviral agents, hypolipidaemic agents, atypical antipsychotic medicines, corticosteroids and other immunosuppressants, COX-2 inhibitors, NSAIDs, aminosalicylates ( Mesalazine, Sulfasalazine ), angiotensin II receptor antagonists, ACE inhibitors and H2-receptor antagonists. Together, these groups ( comprising slightly less than 22% of the entire ADRAC database ) account for more than 60% of the reports of pancreatitis.

Pancreatitis - Commonly reported drugs: Azathioprine 33, Valproate 28, Didanosine 27, Simvastatin 22, Stavudine 17, Clozapine 13, Ezetimibe 10, Lamivudine 10, Prednisolone 9, Olanzapine 8, Celecoxib 7, Mercaptopurine 7.

A causal association has not been firmly established for many of these, but a drug-induced cause should be considered when other causes have been reasonably excluded.

At risk groups include elderly patients taking multiple medications, patients who are HIV positive, patients who have cancer and patients receiving immunomodulatory agents.

There is insufficient information available on the course of the disease once the suspected drug is stopped. It would, however, seem prudent to withdraw the suspected drug(s) and prevent re-exposure.

Source: Australian Adverse Drug Reactions Bulletin, 2007

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