Valproik Asit, Olanzapin ve Risperidonun Birlikte Kullanımından Kaynaklanan Bir Akut Pankreatit Olgusu

Year 2020, Volume: 34 Issue: 2, 163 - 169, 31.08.2020

Sultan Efsun Tamdemir , Bahadır Geniş , Selçuk Aslan Harun Küçük

https://doi.org/10.5505/deutfd.2020.05924

Abstract

Akut pankreatit (AP), pankreas dokusunun etkilendiği geri dönüşlü enflamatuar bir süreçtir. İlaca bağlı akut pankreatit gelişimi, tüm akut pankreatitlerin küçük bir kısmını oluşturur. Duygudurum dengeleyici ve antipsikotik ilaçların akut pankreatite neden olduğu bildirilmiştir. Bu yazıda kliniğimizde takip edilen mani döneminde bir hastanın valproat, olanzapin ve risperidon kullanımı ile ilişkili akut pankreatit vakası sunulmuştur. 63 yaşında kadın hasta kliniğimize, ilaçlarını almayı bıraktıktan sonra başlayan mani belirtileri ile başvurdu. Tedavisi için hastane servisine kabul edildi. Hasta tedavinin 5. gününde AP geliştirdi. Valproat 1000 mg/gün, olanzapin 10 mg/gün ve risperidon 4 mg/gün kullanıyordu. Amilaz (563 U/L) ve lipaz (3764 U/L) değerleri arttı. Mevcut ilaç tedavisinin kesilmesinden sonra, pankreatit semptomları azaldı. Manik semptomlar için 2 mg/gün lorazepam ve 600 mg/gün amisülpirid uygulandı. 3 haftalık tedaviden sonra manik semptomlar belirgin şekilde iyileşmişti. Taburcu olduktan sonraki üçüncü haftada ne pankreatit kliniği ne de manik semptomları yoktu. Ciddi bir mortalite ve morbidite nedeni olan AP, duygudurum dengeleyici ve antipsikotik ilaçlardan kaynaklanabilir. Tedaviye başlandıktan sonraki ilk 4-6 hafta boyunca, hastalar AP gelişimi riski açısından yakından izlenmelidir. AP için bir risk faktörü olarak kabul edilen çoklu ilaç kullanımından kaçınılmalıdır.

Keywords

bipolar bozukluk, pankreatit, olanzapin, valpoik asit, mani

A Case of Acute Pancreatitis Caused by Combined Use of Valproic Acid, Olanzapine and Risperidone

Abstract

Acute pancreatitis (AP) is a reversible inflammatory process in which pancreatic tissue is affected. The development of drug-induced acute pancreatitis constitutes a small proportion of all acute pancreatitis. It has been reported that mood stabilizer and antipsychotic drugs cause acute pancreatitis. We are here presenting a case of acute pancreatitis associated with the use of valproate, olanzapine and risperidone by a patient in the mania period followed in our clinic. A 63-year-old woman patient presented to our clinic with symptoms of mania that began after she stopped taking her medication. She was admitted to the hospital ward for her treatment. The patient developed AP on the 5th day of treatment. She was using valproate 1000 mg/day, olanzapine 10 mg/day and risperidone 4 mg/day. Amylase (563 U/L) and lipase (3764 U/l) values increased. After discontinuation of the current drug therapy, the symptoms of pancreatitis reduced. Alprazolam 2 mg/day and amisulpride 600 mg/day were administered for manic symptoms. After 3 weeks of treatment, manic symptoms had significantly improved. At the third week after discharge, she had neither pancreatitis clinic nor manic symptoms. AP which is a serious cause of mortality and morbidity may be caused by mood stabilizing and antipsychotic drugs. In the first 4-6 weeks period following treatment initiation, patients should be closely monitored for the risk of AP development. Multidrug use, which is considered as a risk factor for AP, should be avoided.

Keywords

bipolar disorder, pancreaititis, olanzapine, valproic acid, mania

References

• Carroll JK, Herrick B, Gipson T, Lee SP. Acute pancreatitis: diagnosis, prognosis, and treatment. Am Fam Physician. 2007;75:1513-20.
• Al-Bahrani AZ, Ammori BJ. Clinical laboratory assessment of acute pancreatitis. Clin Chim Acta. 2005;362:26-48.
• Rettally CA, Skarda S, Garza MA, Schenker S. The usefulness of laboratory tests in the early assessment of severity of acute pancreatitis. Crit Rev Clin Lab Sci. 2003;40:117-49.
• Barreto SG, Tiong L, Williams R. Drug-induced acute pancreatitis in a cohort of 328 patients. A single-centre experience from Australia. JOP. 2011;12:581-5.
• Koller EA, Cross JT, Doraiswamy PM, Malozowski SN. Pancreatitis associated with atypical antipsychotics: from the Food and Drug Administration's MedWatch surveillance system and published reports. Pharmacotherapy. 2003;23:1123-30.
• Gropper D, Jackson CW. Pancreatitis associated with quetiapine use. J Clin Psychopharmacol. 2004;24:343-5.
• Di MY, Liu H, Yang ZY, Bonis PA, Tang JL, Lau J. Prediction Models of Mortality in Acute Pancreatitis in Adults: A Systematic Review. Ann Intern Med. 2016;165:482-90.
• Wei AL, Guo Q, Wang MJ, Hu WM, Zhang ZD. Early complications after interventions in patients with acute pancreatitis. World J Gastroenterol. 2016;22:2828-36.
• Jones MR, Hall OM, Kaye AM, Kaye AD. Drug-induced acute pancreatitis: A review. Ochsner J. 2015;15:45-51.
• Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239-45.
• Gerstner T, Büsing D, Bell N, Longin E, Kasper JM, Klostermann W, et al. Valproic acid-induced pancreatitis: 16 new cases and a review of the literature. J Gastroenterol. 2007;42:39-48.
• Weston-Green K, Huang XF, Deng C. Olanzapine treatment and metabolic dysfunction: a dose response study in female Sprague Dawley rats. Behav Brain Res. 2011;217:337-46.
• Weston-Green K, Huang XF, Lian J, Deng C. Effects of olanzapine on muscarinic M3 receptor binding density in the brain relates to weight gain, plasma insulin and metabolic hormone levels. Eur Neuropsychopharmacol. 2012;22:364-73.
• Kawabe K, Ueno S. A case of acute pancreatitis associated with risperidone treatment. Clin Psychopharmacol Neurosci. 2014;12:67-8.
• Yamaguchi I, Hamada K, Yoshida M, Isayama H, Kanazashi S, Takeuchi K. Risperidone attenuates local and systemic inflammatory responses to ameliorate diet-induced severe necrotic pancreatitis in mice: it may provide a new therapy for acute pancreatitis. J Pharmacol Exp Ther. 2009;328:256-62.
• Hamada K, Yoshida M, Isayama H, Yagi Y, Kanazashi S, Kashihara Y, et al. Possible involvement of endogenous 5-HT in aggravation of cerulein-induced acute pancreatitis in mice. J Pharmacol Sci. 2007;105:240-50.