Portal de Periódicos da CAPES

DRUG-INDUCED ACUTE PANCREATITIS

2006; Lippincott Williams & Wilkins; Volume: 33; Issue: 4 Linguagem: Inglês

10.1097/00006676-200611000-00033

1536-4828

Nison Badalov, Robin Baradarian, K. Iswara, J.J. Li, William M. Steinberg, Scott Tenner,

Lipoproteins and Cardiovascular Health

The diagnosis of drug-induced pancreatitis is difficult to establish. Although there are numerous case reports suggesting a relationship between a drug and pancreatitis, there have been few systematic reviews that have attempted to evaluate the strength of the data establishing causality. In this analysis, we have attempted to establish criteria of causality based on rechallenge data and/or a consistent latency between drug use and pancreatitis to determine the quality of the association. Methods: A MEDLINE search of the English language literature for all cases with acute pancreatitis between 1955-2006 was performed. All published case reports were reviewed by two physicians. In order to be included in the final analysis, published reports needed to provide the name, the duration, and the dose of the drug attributed as causing acute pancreatitis and provide a clear diagnosis of acute pancreatitis. Cases were then analyzed for the following patterns. Cases were considered "definite" if imaging, computed tomography (CT), ultrasonography (US), laparotomy, or autopsy confirmed the presence of acute pancreatitis. Cases were considered "probable" if the typical symptoms were present with a greater than threefold elevation of serum amylase and/or lipase. Results: Based on our analysis of the level of evidence, four classes of drugs could be identified. Class I Drugs includes medications in which at least one case report described a recurrence of acute pancreatitis with a rechallenge with the drug. Class I drugs were further subdivided into Class Ia and Class Ib. Class Ia drugs are the drugs where all potential causes of acute pancreatitis such as gallstones, alcohol, hypertriglyceridemia, and medications were ruled out. Class Ib drugs are drugs in which reports describe a recurrence of pancreatitis with the reintroduction of the drug, however other potential causes of acute pancreatitis were not ruled out. Class II drugs includes drugs in which there is a consistent latency in 75% of the reported cases, however no published case reports with rechallenge. At least four case reports were required to be included in this category. Class III drugs includes drugs that had neither a rechallenge nor a consistent latency period. At least two cases were required to be included in this class. Class IV drugs were similar to Class III drugs, but only one case report is available. Based on our analysis of latency periods, we determined that three types of latencies were appropriate: less than 7 days (short), more than 7 days but less than 90 days (intermediate), and more than 90 days (long). Our search revealed 1214 case reports which allowed classification of 129 drugs. 46 medications met the criteria to be included in Class I, 11 medications met the criteria to be included in Class II, 21 medications met the criteria to be included in Class III, and 41 medications met the criteria to be included in Class IV. Conclusion: This classification system assists clinicians in understanding the evidence and patterns of drug induced acute pancreatitis. Future publications of drugs thought to cause acute pancreatitis should include information necessary for this classification system.