Pancreatitis drugs associated with

Pathogenesis of systemic abnormalities during pancreatitis is associated with a high concentration of pancreatic proteases in the blood, which reduce activation of the blood proteolytic systems. Alteration of the balance between proteases and their natural inhibitors is a trigger of endogenous intoxication syndrome, which controls disease severity and the clinical outcome. Therefore, drugs which act as inhibitors of proteases are an important component of a complex treatment of acute pancreatitis. 

Potential Mechanisms Select Drugs Associated with Acute Pancreatitis... 

Temporal Relationships of Adverse Events. The temporal relationship between duration of product exposure and development of an adverse event is important in assessing causality. But how can data on temporal relationships be systematically summarized in a database containing thousands or even hundreds of thousands of subjects Temporal relationships cannot be clearly elicited if only frequencies of adverse events between treatment and control groups are compared. There can be many disparities in the subjects time of exposure or time at risk. Toxic manifestations of drugs may not occur until several months or even years after the initial exposure to the drug. How do we systematically assess delayed toxicity of a previously prescribed drug from the effect of a newly prescribed drug Such a scenario occurred with reported cases of pancreatitis associated with valproic acid therapy, in which some cases appeared several years after therapy [2]. 

Combination therapy - For toxicities likely to be associated with zalcitabine (eg, peripheral neuropathy, severe oral ulcers, pancreatitis, elevated liver function tests, especially in patients with chronic hepatitis B see Warnings and Precautions), interrupt or reduce dose. For severe toxicities or those persisting after dose reduction, interrupt zalcitabine therapy. For recipients of combination therapy with zalcitabine and other antiretrovirals, base dose adjustments or interruption for either drug on the known toxicity profile of the individual drugs. 

The arylpropionic acid derivatives are useful for the treatment of rheumatoid arthritis and osteoarthritis, for reduction of mild to moderate pain and fever, and for pain associated with dysmenorrhea. Side effects of the drugs are similar to but less severe than those described for the salicylates. Those who are sensitive to salicylates also may be sensitive to and have adverse reactions when taking ibuprofen and related drugs. Acute hypersensitivity to ibuprofen has been reported in patients with lupus. The hypersensitivity reaction to sulindac can be fatal. The use of sulindac has also been linked to cases of acute pancreatitis. The use of dimethylsulfoxide (DMSO) topically in combination with sulindac has been reported to induce severe neuropathies. The concurrent use of ibuprofen with aspirin reduces the antiinflammatory effects of both drugs. Ibuprofen is contraindicated in patients with aspirin sensitivity leading to bronchiolar constriction and in patients with an-gioedema. As with all NSAIDs, renal and liver function should be normal for adequate clearance of the drugs. 

A 29-year-old man presented with acute pancreatitis after a period of heavy cannabis smoking. Other causes of the disease were ruled out. The pancreatitis resolved itself after the cannabis was stopped and this was confirmed by urinary cannabinoid metabolite monitoring in the community. There were no previous reports of acute pancreatitis associated with cannabis use in the general population. Drugs of all types are related to the etiology of pancreatitis in approximately 1.4-2% of cases k Pancreatic toxicity. The dried leaf, smoked by a 19-year-old woman, was active. The subject was hospitalized with pancrea-titis . 

Sulfasalazine has a high incidence of adverse effects, most of which are attributable to systemic effects of the sulfapyridine molecule. Slow acetylators of sulfapyridine have more frequent and more severe adverse effects than fast acetylators. Up to 40% of patients cannot tolerate therapeutic doses of sulfasalazine. The most common problems are dose-related and include nausea, gastrointestinal upset, headaches, arthralgias, myalgias, bone marrow suppression, and malaise. Hypersensitivity to sulfapyridine (or, rarely, 5-ASA) can result in fever, exfoliative dermatitis, pancreatitis, pneumonitis, hemolytic anemia, pericarditis, or hepatitis. Sulfasalazine has also been associated with oligospermia, which reverses upon discontinuation of the drug. Sulfasalazine impairs folate absorption and processing hence, dietary supplementation with 1 mg/d folic acid is recommended. 

The temporal association with carbimazole therapy, the response to rechallenge, and the absence of other causes of acute pancreatitis suggested that the drug was causative in this case. 

Other bothersome side effects are related to specific agents. Niacin, for instance, is often associated with cutaneous vasodilation and a sensation of warmth when doses are administered, but administering an extended-release form of this drug can reduce these sensations.71 99 Some fairly serious problems, including liver dysfunction, gallstones, and pancreatitis, can occur with many antihyperlipidemia drugs, but the incidence of these side effects is rare. Cardiovascular problems such as arrhythmias, blood dyscrasias, and angioneurotic syndrome may also occur with fibric acids. 

However, several types of cancer do not respond well to treatment. For example, the majority of metastatic cancers cannot be cured by current chemotherapeutic methods or by any other type of treatment.11 In addition, some of the most common forms of adult neoplastic disease are difficult to treat by using anticancer drugs. As indicated in Table 36-9, the number of deaths associated with colorectal, prostate, and breast cancer is unacceptably high, and the mortality rate for lung cancer and pancreatic cancer is well over 90 percent in both men and women. 

In a review of definite or probable drug-associated pancreatitis spontaneously reported to the Dutch adverse drug reactions system during 1977-98, azathioprine was the suspected drug in four of 34 patients, two of whom had positive rechallenge (37). Although most of the carefully described reports of azathioprine-induced pancreatitis were found in patients with inflammatory bowel disease, transplant recipients can also suffer this complication. 

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