Confusing adverse drug reactions with new diseases
A 60 year old man presents to the surgery with abdominal pain.
After initial investigations, you diagnose acute pancreatitis as the patient's lipase level is more than 3 times the upper limit.
The patient denies excessive alcohol intake (the most commonly used drug causing pancreatitis).
An ultrasound scan subsequently shows it is not due to gallstones or duct obstruction.
You test for metabolic hypercalcaemia and hypertriglyceridemia and autoimmune pancreatitis – all are negative
What would your next action be? – Yes, this is the chapter on adverse drug reactions.
Incidence of ADRs
The next thing to consider is what medication is the patient taking?
If you consider that a drug treatment he is taking is responsible then discontinue the drug if safely possible; if not substitute with a different medicine.
If the symptoms resolve after stopping, then drug induced pancreatitis is probable. Inform the patient and consider re-exposure only if benefits outweigh the risk. If the symptoms re-appear on re-exposure then this is probably drug-induced pancreatitis. Stop the drug causing the symptom/condition and notify the MHRA via the Yellow Card Scheme.
What should this make you think? Consider an adverse drug reaction as part of any differential diagnosis.
Some of the drugs with a definite association to pancreatitis as reported in case reports and cited as Table 3 in C.J. Nitsche et al. / Best Practice & Research Clinical Gastroenterology 24 (2010) 143–155
Paracetamol/Acetaminophen
Azathioprine
Cimetidine
Cisplatin
Cytarabine
Didanosine
Enalapril
Erythromycin
Oestrogens
Furosemide
Hydrochlorothiazide
Interferon-a2b
Lamivudine
Mercaptopurine
Mesalamine/Olsalazine
Methyldopa
Metronidazole
Octreotide
Opiates
Oxyphenbutazone
Pentamidine
Pentavalent anti-Monials
Phenformin
Simvastatin
Steroids
Sulfasalazine
Sulfmethaxazole/Trimethoprim
Sulindac
Tetracycline
Valproic acid
This case is adapted from Drug induced pancreatitis (Nitsche et al 2010)
Copyright eBook 2019, University of Leeds, Leeds Institute of Medical Education.