What medications can cause pancreatitis?

From the Guidelines

Medications such as azathioprine, GLP-1 RAs, and DPP-4 inhibitors can cause pancreatitis as a side effect, and patients should be warned about the risk of pancreatitis and seek urgent medical attention if symptoms occur. Several medications can cause pancreatitis, including immunosuppressants like azathioprine 1 and certain diabetes medications such as GLP-1 RAs and DPP-4 inhibitors 1. The risk of pancreatitis varies based on individual factors, medication dose, and duration of use. Drug-induced pancreatitis typically occurs through direct toxic effects on pancreatic cells, immunologic reactions, accumulation of toxic metabolites, or by causing duct obstruction or increasing triglyceride levels.

Common Medications Associated with Pancreatitis

• Immunossuppressants: azathioprine 1
• Diabetes medications: GLP-1 RAs, DPP-4 inhibitors 1 Symptoms of medication-induced pancreatitis include abdominal pain, nausea, vomiting, and elevated pancreatic enzymes. If you develop these symptoms while taking any medication, seek immediate medical attention. Treatment usually involves discontinuing the offending drug and providing supportive care. Patients with a history of pancreatitis should inform their healthcare providers before starting new medications.

From the FDA Drug Label

Pancreatitis [see Boxed Warning, Warnings and Precautions (5.1)] In clinical trials using a buffered formulation of didanosine, pancreatitis resulting in death was observed in one patient who received didanosine plus stavudine plus nelfinavir, one patient who received didanosine plus stavudine plus indinavir, and 2 of 68 patients who received didanosine delayed-release capsules plus stavudine plus indinavir plus hydroxyurea In an early access program, pancreatitis resulting in death was observed in one patient who received didanosine plus stavudine plus hydroxyurea plus ritonavir plus indinavir plus efavirenz Exocrine Gland Disorders - pancreatitis (including fatal cases) [see Warnings and Precautions (5.1)], sialoadenitis, parotid gland enlargement, dry mouth, and dry eyes.

Medications that can cause pancreatitis include:

• Didanosine
• Stavudine
• Hydroxyurea
• Ritonavir
• Indinavir
• Efavirenz
• Nelfinavir
• Tenofovir disoproxil fumarate (when coadministered with didanosine)
• Other medications that may cause pancreatic toxicity, when used with didanosine. 2, 2, 2

From the Research

Medications Implicated in Pancreatitis

The following medications have been implicated in causing pancreatitis:

• Agents with a definite association with pancreatitis:
  • asparaginase 3, 4, 5, 6
  • azathioprine 3, 4, 5, 6
  • didanosine 3, 7
  • estrogens 3, 4, 5, 6
  • furosemide 3, 4, 5
  • mercaptopurine 3, 7
  • pentamidine 3, 7, 5, 6
  • sulfonamides 3, 4, 5, 6
  • sulindac 3, 7, 6
  • tetracyclines 3, 4, 5, 6
  • thiazides 3, 4, 5
  • valproic acid 3, 7, 5, 6
• Agents with a probable association with pancreatitis:
  • cimetidine 3
  • clozapine 3
  • corticosteroids 3, 4, 5, 6
  • endoscopic retrograde cholangiopancreatography contrast media 3
  • methyldopa 3
  • metronidazole 3, 6
  • salicylates 3, 6
  • zalcitabine 3
• Agents with a questionable association with pancreatitis:
  • acetaminophen 3, 7
  • cyclosporine 3, 6
  • cytarabine 3, 7
  • erythromycin and roxithromycin 3, 7
  • ketoprofen 3
  • metolazone 3
  • octreotide 7, 6

Classification of Medications Implicated in Pancreatitis

Medications implicated in pancreatitis can be classified into three classes based on the strength of evidence:

• Class I medications: implicated in greater than 20 reported cases of acute pancreatitis with at least one documented case following reexposure 7
• Class II medications: implicated in more than 10 cases of acute pancreatitis 7
• Class III medications: all medications reported to be associated with pancreatitis 7