Simvastatin-Induced Acute Pancreatitis: A rare side effect of a statin
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Published:
Sep 20, 2013
Keywords:
acute pancreatitis, simvastatin, statin, HMG-CoA, side effect, drug induced pancreatitis
Main Article Content
Abstract
Acute Pancreatitis is dened as the abrupt nonbacterial inammation of the pancreas. Typical symptoms comprise of abdominal pain located in the epigastrium and radiating to the back. In the majority of cases, the progression of acute pancreatitis is mild and self-limited. Albeit, one fth of patients may deteriorate and develop multiple organ dysfunction syndrome (MODS) which eventually enhance smortality rate.1,2 The rst and second most common etiologies, accounting for approximately 75% of cases in most developed countries, are gallstones and alcohol respectively.3 Less common causes include pancreatitis occurring after endoscopic retrograde cholangiopancreatography (ERCP), abdominal trauma, familial hypertriglyceridemia, hypercalcemia, autoimmune disease, toxins, etc.4,5 Drug-induced pancreatitis is a relatively rare occurrence, accounting for approximately 1.2-2% of cases.6-8 Of those, acute pancreatitis caused by the 3-hydroxy-3- methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, often referred to as statins, has been reported rarely.9 We reported a case experiencing the very rare side effect of simvastatin-associated acute pancreatitis. This information should increase awareness of physicians and pharmacists not to overlook the etiology particularly in any patients diagnosed with idiopathic pancreatitis.
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1.
Suwansiripat S, Saengpattrachai M, Shivawongsri S, Choomduang P, Kukreja R. Simvastatin-Induced Acute Pancreatitis: A rare side effect of a statin. BKK Med J [Internet]. 2013 Sep. 20 [cited 2024 Apr. 25];6(1):63. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/218624
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References
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3. Whitcomb DC, Yadav D, Adam S, et al. Multicenter approach to recurrent acute and chronic pancreatitis in the United States: the North American Pancreatitis Study 2 (NAPS2). Pancreatology 2008;8:520-31.
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5. Somogyi L, Martin SP, Venkatesan T, et al. Recurrent acute pancreatitis: an algorithmic approach to identification and elimination of inciting factors. Gastroenterology 2001;120:708-17.
6. Sekimoto M, Takada T, Kawarada Y, et al. JPN guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J Hepatobiliary Pancreat Surg 2006;13:10-24.
7. Lankisch PG, Droge M, Gottesleben F. Drug-induced acute pancreatitis: incidence and severity. Gut 1995; 37:565-7.
8. McArthur, KE. Review article: Drug-induced pancreatitis. Aliment Pharmacol & Therap 1996;10:23-8.
9. Murinello A, Pinheiro E. Acute pancreatitis due to simvastatin. J Port Gastrenterol 2006;13:92-6.
10. Balthazar EJ, Freeny PC, vanSonnenberg E. Imaging and intervention in acute pancreatitis. Radiology 1994; 193:297-306.
11. Balthazar EJ. Acute pancreatitis: Assessment of severity with with clinical and CT evaluation. Radiology 2002;223: 603-13.
12. Balthazar EJ, Fisher LA. Hemorrhagic complications of pancreatitis: Radiologic evaluation with emphasis on CT imaging. Pancreatology 2001;1:306-13.
13. Badalov N, Baradarian R, Iswara K, et al. Drug-Induced Acute Pancreatitis: An Evidence-Based Review. Clinical Gastroenterology and Hepatology 2007;5:648-61.
14. Trivedi CD, Pitchumoni CS. Drug-Induced Pancreatitis: An Update. J Clin Gastroenterol 2005;39:709-16.
15. Denker PS, Dimarco PE. Exenatide (exendin-4)-induced pancreatitis: a case report. Diabetes Care 2006;29:471.
16. Ahmad I, Ruby E, Usman H, et al. Ezetimibe-induced acute pancreatitis. South Med J 2007;100:409-10.
17. Jibrin I, Erinle A, Saidi A, et al. Saw palmetto-induced pancreatitis. South Med J 2006;99:611-2.
18. Kaurich T. Drug-induced acute pancreatitis. Proc (Bayl Univ Med Cent) 2008;21:77-81.
19. Thisted H, Jacobsen J, Munk EM, et al. Statins and the risk of acute pancreatitis: a population-based case-control study. Aliment Pharmacol Ther 2006;23:185-90.
20. Singh S, Nautiyal A, Dolan JG. Recurrent acute pancreatitis possibly induced by atorvastatin and rosuvastatin. Is statin-induced pancreatitis a class effect? JOP. J Pancreas (Online) 2004;5:502-4.
21. Singh S, Loke YK. Statins and pancreatitis: a systematic review of observational studies and spontaneous case reports. Drug Saf 2006;29:1123-32.
22. Johnson JL, Loomis IB. A case of simvastatin-associated pancreatitis and review of statin-associated pancreatitis. Pharmacotherapy 2006;26:414-22.
23. Wong PW, Dillard TA, Kroenke K. Multiple organ toxicity from addition of erythromycin to long-term lovastatin therapy. South Med J 1998;91:202-5.
24. Miltiadous G, Anthopoulon A, Elisaf M. Acute pancreatitis possibly associated with combined salycilate and atorvastatin therapy. JOP. J Pancreas (Online) 2003;4:20-1.
25. Belaiche G, Ley G, Slama JL. Acute pancreatitis associated with atorvastatin therapy. Gastroenterol Clin Biol 2000;24:471-2.
26. Anagnostopoulos GK, Tsiakos S, Margantinis G, Kostopoulos P, Arvanitidis D. Acute pancreatitis due to pravastatin therapy. JOP. J Pancreas (Online) 2003;4:129-32.
27. Werner J, Feuerbach S, Uhl W, et al. Management of acute pancreatitis: From surgery to interventional intensive care. Gut 2005;54:426-36.
28. Dziurkowska-Marek A, Marek TA, Nowak A, et al. The dynamics of the oxidant-antioxidant balance in the early phase of human acute biliary pancreatitis. Pancreatology 2004;4:215-22.
29. Lankisch PG, Mahlke R, Blum T, et al. Hemoconcentration: An early marker of severe and/or necrotizing pancreatitis? A critical appraisal. Am J Gastroenterol 2001;96:2081-5.
30. Blum T, Maisonneuve P, Lowenfels AB, et al. Fatal outcome in acute pancreatitis: Its occurrence and early prediction. Pancreatology 2001;1:237-41.
31. Lankisch PG, Pflichthofer D, Lehnick D. No strict correlation between necrosis and organ failure in acute pancreatitis. Pancreas 2000;20:319-22.
32. Khan AA, Parekh D, Cho Y, et al. Improved prediction of outcome in patients with severe acute pancreatitis by the APACHE II score at 48 hours after hospital admission compared with the APACHE II score at admission. Acute physiology and chronic health evaluation. Arch Surg 2002;137:1136-40.
33. Connor S, Ghaneh P, Raraty M, et al. Increasing age and APACHE II scores are the main determinants of outcome from pancreatic necrosectomy. Br J Surg 2003;90:1542-8.
34. Mery CM, Rubio V, Duarte-Rojo A, et al. Android fat distribution as predictor of severity in acute pancreatitis. Pancreatology 2002;2:543-9.
35. Gloor B, Muller CA, Worni M, et al. Late mortality in patients with severe acute pancreatitis. Br J Surg 2001; 88:975-9.
36. Halonen KI, Leppaniemi AK, Puolakkainen PA, et al. Severe acute pancreatitis: Prognostic factors in 270 consecutive patients. Pancreas 2000;21:266-71.
37. Polyzogopoulou E, Bikas C, Danikas D, et al. Baseline hypoxemia as a prognostic marker for pulmonary com plications and outcome in patients with acute pancreatitis. Dig Dis Sci 2004;49:150-4.
38. Isenmann R, Rau B, Beger HG. Bacterial infection and extent of necrosis are determinants of organ failure in patients with acute necrotizing pancreatitis. Br J Surg 1999;86:1020-4.
39. Company L, Saez J, Martinez J, et al. Factors predicting mortality in severe acute pancreatitis. Pancreatology 2003;3:144-8.
40. Lankisch PG, Assmus C, Lehnick D, et al. Acute pancreatitis: Does gender matter? Dig Dis Sci 2001;46:2470-4.
41. Talamini G, Bassi C, Falconi M, et al. Risk of death from acute pancreatitis. Role of early, simple “routine” data. Int J Pancreatol 1996;19:15-24.
42. Mutinga M, Rosenbluth A, Tenner SM, et al. Does mortality occur early or late in acute pancreatitis? Int J Pancreatol 2000;28:91-5.
43. Gullo L, Migliori M, Olah A, et al. Acute pancreatitis in five European countries: Etiology and mortality. Pancreas 2002;24:223-7.
44. Hartwig W, Werner J, Muller CA, et al. Surgical management of severe pancreatitis including sterile necrosis. J Hepatobiliary Pancreat Surg 2002;9:429-35.
45. Mettu SR,Wig JD, Khullar M, et al. Efficacy of serum nitric oxide level estimation in assessing the severity of necrotizing pancreatitis. Pancreatology 2003;3:506-13; discussion 513-4.
46. Garg PK, Madan K, Pande GK, et al. Association of extent and infection of pancreatic necrosis with organ failure and death in acute necrotizing pancreatitis. Clin Gastroenterol Hepatol 2005;3:159-66
47. de Beaux AC, Palmer KR, Carter DC. Factors influencing morbidity and mortality in acute pancreatitis; an analysis of 279 cases. Gut 1995;37:121-6.
48. Perez A, Whang EE, Brooks DC, et al. Is severity of necrotizing pancreatitis increased in extended necrosis and infected necrosis? Pancreas 2002;25:229-33.
2. Cruz-Santamaria DM, Taxonera C, Giner M. Update on pathogenesis and clinical management of acute pancreatitis. World J Gastrointes Pathophysiol 2012;3:60-70.
3. Whitcomb DC, Yadav D, Adam S, et al. Multicenter approach to recurrent acute and chronic pancreatitis in the United States: the North American Pancreatitis Study 2 (NAPS2). Pancreatology 2008;8:520-31.
4. Forsmark CE, Baillie J. AGA Institute technical review on acute pancreatitis. Gastroenterology 2007;132:2022- 44.
5. Somogyi L, Martin SP, Venkatesan T, et al. Recurrent acute pancreatitis: an algorithmic approach to identification and elimination of inciting factors. Gastroenterology 2001;120:708-17.
6. Sekimoto M, Takada T, Kawarada Y, et al. JPN guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J Hepatobiliary Pancreat Surg 2006;13:10-24.
7. Lankisch PG, Droge M, Gottesleben F. Drug-induced acute pancreatitis: incidence and severity. Gut 1995; 37:565-7.
8. McArthur, KE. Review article: Drug-induced pancreatitis. Aliment Pharmacol & Therap 1996;10:23-8.
9. Murinello A, Pinheiro E. Acute pancreatitis due to simvastatin. J Port Gastrenterol 2006;13:92-6.
10. Balthazar EJ, Freeny PC, vanSonnenberg E. Imaging and intervention in acute pancreatitis. Radiology 1994; 193:297-306.
11. Balthazar EJ. Acute pancreatitis: Assessment of severity with with clinical and CT evaluation. Radiology 2002;223: 603-13.
12. Balthazar EJ, Fisher LA. Hemorrhagic complications of pancreatitis: Radiologic evaluation with emphasis on CT imaging. Pancreatology 2001;1:306-13.
13. Badalov N, Baradarian R, Iswara K, et al. Drug-Induced Acute Pancreatitis: An Evidence-Based Review. Clinical Gastroenterology and Hepatology 2007;5:648-61.
14. Trivedi CD, Pitchumoni CS. Drug-Induced Pancreatitis: An Update. J Clin Gastroenterol 2005;39:709-16.
15. Denker PS, Dimarco PE. Exenatide (exendin-4)-induced pancreatitis: a case report. Diabetes Care 2006;29:471.
16. Ahmad I, Ruby E, Usman H, et al. Ezetimibe-induced acute pancreatitis. South Med J 2007;100:409-10.
17. Jibrin I, Erinle A, Saidi A, et al. Saw palmetto-induced pancreatitis. South Med J 2006;99:611-2.
18. Kaurich T. Drug-induced acute pancreatitis. Proc (Bayl Univ Med Cent) 2008;21:77-81.
19. Thisted H, Jacobsen J, Munk EM, et al. Statins and the risk of acute pancreatitis: a population-based case-control study. Aliment Pharmacol Ther 2006;23:185-90.
20. Singh S, Nautiyal A, Dolan JG. Recurrent acute pancreatitis possibly induced by atorvastatin and rosuvastatin. Is statin-induced pancreatitis a class effect? JOP. J Pancreas (Online) 2004;5:502-4.
21. Singh S, Loke YK. Statins and pancreatitis: a systematic review of observational studies and spontaneous case reports. Drug Saf 2006;29:1123-32.
22. Johnson JL, Loomis IB. A case of simvastatin-associated pancreatitis and review of statin-associated pancreatitis. Pharmacotherapy 2006;26:414-22.
23. Wong PW, Dillard TA, Kroenke K. Multiple organ toxicity from addition of erythromycin to long-term lovastatin therapy. South Med J 1998;91:202-5.
24. Miltiadous G, Anthopoulon A, Elisaf M. Acute pancreatitis possibly associated with combined salycilate and atorvastatin therapy. JOP. J Pancreas (Online) 2003;4:20-1.
25. Belaiche G, Ley G, Slama JL. Acute pancreatitis associated with atorvastatin therapy. Gastroenterol Clin Biol 2000;24:471-2.
26. Anagnostopoulos GK, Tsiakos S, Margantinis G, Kostopoulos P, Arvanitidis D. Acute pancreatitis due to pravastatin therapy. JOP. J Pancreas (Online) 2003;4:129-32.
27. Werner J, Feuerbach S, Uhl W, et al. Management of acute pancreatitis: From surgery to interventional intensive care. Gut 2005;54:426-36.
28. Dziurkowska-Marek A, Marek TA, Nowak A, et al. The dynamics of the oxidant-antioxidant balance in the early phase of human acute biliary pancreatitis. Pancreatology 2004;4:215-22.
29. Lankisch PG, Mahlke R, Blum T, et al. Hemoconcentration: An early marker of severe and/or necrotizing pancreatitis? A critical appraisal. Am J Gastroenterol 2001;96:2081-5.
30. Blum T, Maisonneuve P, Lowenfels AB, et al. Fatal outcome in acute pancreatitis: Its occurrence and early prediction. Pancreatology 2001;1:237-41.
31. Lankisch PG, Pflichthofer D, Lehnick D. No strict correlation between necrosis and organ failure in acute pancreatitis. Pancreas 2000;20:319-22.
32. Khan AA, Parekh D, Cho Y, et al. Improved prediction of outcome in patients with severe acute pancreatitis by the APACHE II score at 48 hours after hospital admission compared with the APACHE II score at admission. Acute physiology and chronic health evaluation. Arch Surg 2002;137:1136-40.
33. Connor S, Ghaneh P, Raraty M, et al. Increasing age and APACHE II scores are the main determinants of outcome from pancreatic necrosectomy. Br J Surg 2003;90:1542-8.
34. Mery CM, Rubio V, Duarte-Rojo A, et al. Android fat distribution as predictor of severity in acute pancreatitis. Pancreatology 2002;2:543-9.
35. Gloor B, Muller CA, Worni M, et al. Late mortality in patients with severe acute pancreatitis. Br J Surg 2001; 88:975-9.
36. Halonen KI, Leppaniemi AK, Puolakkainen PA, et al. Severe acute pancreatitis: Prognostic factors in 270 consecutive patients. Pancreas 2000;21:266-71.
37. Polyzogopoulou E, Bikas C, Danikas D, et al. Baseline hypoxemia as a prognostic marker for pulmonary com plications and outcome in patients with acute pancreatitis. Dig Dis Sci 2004;49:150-4.
38. Isenmann R, Rau B, Beger HG. Bacterial infection and extent of necrosis are determinants of organ failure in patients with acute necrotizing pancreatitis. Br J Surg 1999;86:1020-4.
39. Company L, Saez J, Martinez J, et al. Factors predicting mortality in severe acute pancreatitis. Pancreatology 2003;3:144-8.
40. Lankisch PG, Assmus C, Lehnick D, et al. Acute pancreatitis: Does gender matter? Dig Dis Sci 2001;46:2470-4.
41. Talamini G, Bassi C, Falconi M, et al. Risk of death from acute pancreatitis. Role of early, simple “routine” data. Int J Pancreatol 1996;19:15-24.
42. Mutinga M, Rosenbluth A, Tenner SM, et al. Does mortality occur early or late in acute pancreatitis? Int J Pancreatol 2000;28:91-5.
43. Gullo L, Migliori M, Olah A, et al. Acute pancreatitis in five European countries: Etiology and mortality. Pancreas 2002;24:223-7.
44. Hartwig W, Werner J, Muller CA, et al. Surgical management of severe pancreatitis including sterile necrosis. J Hepatobiliary Pancreat Surg 2002;9:429-35.
45. Mettu SR,Wig JD, Khullar M, et al. Efficacy of serum nitric oxide level estimation in assessing the severity of necrotizing pancreatitis. Pancreatology 2003;3:506-13; discussion 513-4.
46. Garg PK, Madan K, Pande GK, et al. Association of extent and infection of pancreatic necrosis with organ failure and death in acute necrotizing pancreatitis. Clin Gastroenterol Hepatol 2005;3:159-66
47. de Beaux AC, Palmer KR, Carter DC. Factors influencing morbidity and mortality in acute pancreatitis; an analysis of 279 cases. Gut 1995;37:121-6.
48. Perez A, Whang EE, Brooks DC, et al. Is severity of necrotizing pancreatitis increased in extended necrosis and infected necrosis? Pancreas 2002;25:229-33.