Acute pancreatitis generally causes severe abdominal pain, nausea and vomiting.

Most patients recover with no local or general complications and without a recurrence. However, in some patients, necrosis of the pancreas or the surrounding tissue occurs, with sometimes fatal local and general complications.

Treatment is chiefly of the symptoms, for lack of anything better.

The most frequent known causes of acute pancreatitis are gallstones and excessive alcohol consumption.

Sometimes medication can be the cause.

An increasing number of drugs are implicated, such as some glucose-lowering agents which increase the secretion of insulin: exenatide, liraglutide and sitagliptine.

Other drugs identified by the Toulouse regional pharmacovigilance centre are sometimes implicated: antivirals, particularly didanosine, antibiotics, especially sulfamethoxazole + trimethoprim, analgesics including paracetamol, numerous anticancer drugs, anticholesterol drugs, particularly atorvastatin, immunosuppressants, especially azathioprine, corticosteroids, glucose-lowering drugs, and antiepileptics, particularly valproic acid. Ketoprofen, mesalazine, venlafaxine and ramipril were also implicated.

In the case of abdominal pain, it is important for patients to be aware that their medication could be the cause, and to share this information with their doctor or pharmacist.

©Prescrire 1 April 2014

"Drug-induced acute pancreatitis" Prescrire Int 2014; 23 (148): 101. (Pdf, subscribers only).