https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7179987/pdf/cureus-0012-00000007389.pdf

Sitagliptin-induced Pancreatitis: Chronic Use Would Not Spare You the Complication

Talal Alkayali, Juan Ricardo, Kafayat Busari, Ibrahim Saad

Abstract:

Medication-induced pancreatitis is an overlooked cause of acute pancreatitis. We present an 81-year-old male patient with acute sharp epigastric pain radiating to his back, who was found to have lipase of more than 30,000 U/L. The patient denied current alcohol use. Abdominal ultrasound and abdominal computed tomography scan revealed no gallstones or biliary duct abnormalities. The patient had been taking sitagliptin for eight years. Supportive treatment with intravenous fluids, pain medications, and early feeding adequately treated his disease. With our case, we aim to increase awareness of sitagliptin-induced pancreatitis, regardless of the duration of use.

Summary:

The patient I presented during my second site visit was a diabetic taking Janumet (Sitagliptin/Metformin) who presented with epigastric pain, after CT abdomen she was diagnosed with pancreatitis likely drug induced as she had no gallstones and does not drink alcohol. I chose this article because it followed a case report with a similar presentation to the patient that I saw while also discussing PE findings, workup, imaging, and treatment. Acute pancreatitis has a sudden onset. Drug induced pancreatitis is uncommon, only 0.1-0.2% of all acute pancreatitis cases. More common causes are gallstones and alcohol. Sitagliptin is an oral DPP-4 inhibitor used to treat diabetes mellitus. This medication has an association with pancreatitis, but there is some controversy and a clear cut relationship has yet to be identified. The patient in the article had severe stabbing epigastric pain starting suddenly after eating with nausea and no vomiting or chest pain. There was epigastric tenderness with negative Murphy’s sign. Lipase was elevated, most other labs were normal. CT abdomen had findings associated with acute pancreatitis. The patient was treated by discontinuing sitagliptin, NPO, IV fluids, analgesia and improved within 24 hours. It is important to identify medication induced pancreatitis early and to stop the offending agent in order to reduce the need for unnecessary testing and recurrence of pancreatitis, DDP-4 inhibitors should always be considered as a potential cause of acute pancreatitis even when a patient has been taking them for a long time without any adverse effects.

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