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Drug-Induced Acute Pancreatitis Confirmed By Positive Re-challenge

Neila Fathallah, Raoudha Slim, Sofien Larif, Houssem Hmouda, Jaballah Sakhri, and Chaker Ben Salem

Drug-induced pancreatitis is a rare but severe adverse drug reaction with an incidence of 0.1-2%. More recent reports have estimated an incidence of up to 5%. Over 500 medications have been associated with this disease. Recrudescence of pancreatotoxicity upon re-exposure to the suspicious drug is considered the more reliable evidence of drug-induced pancreatitis. A retrospective review of MEDLINE was conducted to assess clinical outcomes of positive drug re-challenge following possible drug-induced pancreatitis. A total number of 250 cases of drug-induced pancreatitis with positive re-challenge were identified, among which, 183 met inclusion criteria for analysis in our review. A broad spectrum of suspect drugs was identified. Analgesics and anti-inflammatory drugs were incriminated in 30% of all cases, antibacterials in 18.6%, and cardiovascular agents in 10.9% of cases, immunomodulators in 11% of cases and gastro-intestinal drugs in 4.9% of cases. Improved identification and communication of possible drug-induced pancreatitis is needed to avoid potentially serious and/or fatal drug rechallenges.