Mayo Clinic Family Medicine, Scottsdale, AZ 85260, USA.
Am J Health Syst Pharm. 2010 Feb 1;67(3):214-6. doi: 10.2146/ajhp080519.
A case of acute pancreatitis associated with lisinopril and olanzapine is described.
A 69-year-old woman came to the emergency department after four days of experiencing epigastric pressurelike pain that radiated to the left lower quadrant and worsened with ingestion of food. She had started lisinopril three months prior for treatment of hypertension and had been taking olanzapine regularly for bipolar disorder. Upon admission, she was afebrile and hemodynamically stable and exhibited tenderness of the epigastric region. Elevated pancreatic enzymes and abdominal computed tomography (CT) imaging findings confirmed the diagnosis of pancreatitis. Common causes of pancreatitis were ruled out, and it was determined that the recent combination of lisinopril and olanzapine was the likely cause. Food and liquids were withheld, and all oral medications were stopped at hospital admission. Her pain resolved completely after two days. She was discharged on hospital day 4, and all of her medications except lisinopril and olanzapine were resumed. During a follow-up visit with her primary care physician, she reported to be doing well and had no systemic complaints. Olanzapine was reinitiated at that time but was discontinued a month later by her psychiatrist, who was concerned about the development of recurrent symptoms of pancreatitis. Valsartan was prescribed to achieve optimal blood pressure control three weeks after discharge. A follow-up CT scan of the abdomen a month later found no residual pancreatic abnormalities.
The additive effect of two known pancreatitis-causing medications resulted in increased risk and subsequent acute pancreatitis in this patient.
描述了一例与赖诺普利和奥氮平相关的急性胰腺炎病例。
一名 69 岁女性因四天来经历上腹痛，向左下腹放射，并在进食后加重而到急诊科就诊。她三个月前因高血压开始服用赖诺普利，一直定期服用奥氮平治疗双相情感障碍。入院时，她无发热，血流动力学稳定，上腹部有压痛。胰腺酶升高和腹部 CT 影像学检查结果证实了胰腺炎的诊断。排除了胰腺炎的常见病因，并确定最近赖诺普利和奥氮平联合使用是可能的原因。入院时禁食和停止所有口服药物。两天后疼痛完全缓解。她在入院第 4 天出院，除赖诺普利和奥氮平以外的所有药物均恢复使用。在与她的初级保健医生的随访就诊中，她报告情况良好，没有全身不适。当时重新开始使用奥氮平，但一个月后被她的精神科医生停用，因为担心会出现胰腺炎的复发症状。出院后三周开了缬沙坦以实现最佳血压控制。一个月后的腹部 CT 扫描发现胰腺无残留异常。
两种已知可引起胰腺炎的药物的联合作用导致该患者的风险增加，并随后发生急性胰腺炎。
