Open AccessSitagliptin-induced Pancreatitis: A case report and plausible mechanism
Author(s) -
Kamel El-Reshaid,
Shaikha Al-Bader,
Zaneta Markova
Publication year - 2021
Publication title -
journal of drug delivery and therapeutics
Language(s) - English
Resource type - Journals
ISSN - 2250-1177
DOI - 10.22270/jddt.v11i3.4679
Subject(s) - sitagliptin , medicine , gliclazide , pancreatitis , metformin , abdominal pain , acute pancreatitis , diabetes mellitus , gallstones , type 2 diabetes mellitus , abdomen , hypoglycemia , gastroenterology , dipeptidyl peptidase 4 inhibitor , surgery , endocrinology
Drugs are rare cause of acute pancreatitis (AP) with an estimate incidence of 0.1-2%. We present an 63-year-man 1 week history of severe and progressive epigastric pain that radiates to the back and is worse on lying down, who was found to have lipase of more than 813 IU/L. The patient denied current alcohol use. Abdominal ultrasound and abdominal computed tomography scan did not show gallstones or biliary duct abnormalities. For his type-2 diabetes mellitus, he was taking Gliclazide and Metformin for years and Sitagliptin was the only drug added 6 months ago. He was managed conservatively with intravenous fluids, pain medications, and control of diabetes with insulin. Within 3 days, he improved dramatically and was discharged on diabetic diet and Gliclazide 120 mg daily with Lantos 10 units at night. He was instructed to avoid oral hypoglycemia agents from the dipeptidyl-peptidase IV inhibitors (DPP-4i) group. Three weeks later, repeat computed tomography scan of the abdomen showed normal pancreas. On follow up; and up to 1 year, he did not have subsequent AP. The most plausible mechanism of such late-development of rare drug-induced AP is late-encounter with triggering factor/s for Sitagliptin in genetically-predisposed individuals.
Keywords: CT scan, diabetes mellitus, DPP-4i, metformin, pancreatitis, Sitagliptin.