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Bischof MCM, Stadelmann MIE, Janett S, Bianchetti MG, Camozzi P, Goeggel Simonetti B, Lava SAG, Milani GP. Valproic Acid-Associated Acute Pancreatitis: Systematic Literature Review. J Clin Med 2023; 12:6044. [PMID: 37762984 PMCID: PMC10531745 DOI: 10.3390/jcm12186044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/06/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Long-term medication with valproic acid has been associated with acute pancreatitis. The purpose of this report is to gain insight into the features of this pancreatitis. A preregistered literature search (CRD42023438294) was performed on the National Library of Medicine, Excerpta Medica, Web of Science, and Google Scholar. Patients with alcohol abuse disorder, gallstone disease, hypertriglyceridemia or hypercalcemia, patients with acute valproic acid intoxication, and patients with a pre-existing pancreatitis were excluded. For the final analysis, we retained 73 reports published between 1979 and 2023, which described 125 subjects (83 children and 42 adults predominantly affected by an epilepsy) with an acute pancreatitis related to valproic acid. The diagnosis was made 11 (3.0-24) months (median and interquartile range) after starting valproic acid. One hundred and five cases (84%) recovered and twenty (16%) died. Sex, age, dosage or circulating level of valproic acid, latency time, prevalence of intellectual disability, and antiepileptic co-medication were similar in cases with and without a lethal outcome. Nineteen subjects were rechallenged with valproic acid after recovery: sixteen (84%) cases developed a further episode of pancreatitis. In conclusion, pancreatitis associated with valproic acid presents at any time during treatment and has a high fatality rate.
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Affiliation(s)
- Monica C. M. Bischof
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland (M.I.E.S.); (P.C.)
| | - Mariana I. E. Stadelmann
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland (M.I.E.S.); (P.C.)
| | - Simone Janett
- Department of Pneumology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Sleep Center, Neurocenter of the Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Mario G. Bianchetti
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland (M.I.E.S.); (P.C.)
| | - Pietro Camozzi
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland (M.I.E.S.); (P.C.)
| | - Barbara Goeggel Simonetti
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Sebastiano A. G. Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, University of Lausanne, 1011 Lausanne, Switzerland;
- Clinical Pharmacology & Therapeutics Group, University College London, London WC1N 3JH, UK
| | - Gregorio P. Milani
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
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Yazıcı Ö, Kara M, Boran T, Ozhan G. The Role of Endoplasmic Reticulum Stress in Cell Injury Induced by Methimazole on Pancreatic Cells. Adv Pharm Bull 2023; 13:196-201. [PMID: 36721818 PMCID: PMC9871271 DOI: 10.34172/apb.2023.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 02/03/2023] Open
Abstract
Purpose: Methimazole is an anti-thyroid agent, especially as main therapy option for Graves' disease in children and adults. Drug induced pancreatitis is one of the known adverse effect of methimazole mentioned in case reports. However, the detailed molecular mechanisms of methimazole-induced pancreatitis are still unclear. In this study, the aim is to investigate the adverse effect of methimazole on pancreas cell stress mechanism and apoptosis. Methods: Cytotoxicity was evaluated in human pancreas/duct (PANC-1) cell line. Total oxidant (TOS) and antioxidant status (TAS) for oxidative stress index, glutathione (GSH) level and endoplasmic reticulum (ER) stress biomarkers were evaluated by ELISA. Reactive oxygen species (ROS) levels and apoptosis were evaluated by flow-cytometer. Results: The 30% inhibition rate concentration (IC30) value was determined as 53 mM in PANC1 cells. The exposure concentrations were in the range of 0-40 mM for 48 hours. Methimazole might induce cellular stress conditions. ROS production increases depending on concentration, and this increase shows parallelism with the increase in ER stress biomarkers such as TOS, ERN1 and CASPASE12. Conversely, there was no significant difference between control and exposure groups in terms of apoptosis. Conclusion: In conclusion, methimazole might have triggered the mechanisms of inflammation or autophagy in the pancreatic cells. However, there is still a need for in vitro and in vivo studies including other cellular parameters related to apoptosis.
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Affiliation(s)
- Özge Yazıcı
- Both authors contributed equally as the first authors
| | - Mehtap Kara
- Both authors contributed equally as the first authors
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Chauhan V, Sharma M, Kapur A, Garg GK. Valproate Induced Acute Pancreatitis - A Unique Case Report. Curr Drug Saf 2022; 17:387-389. [PMID: 35196972 DOI: 10.2174/1574886317666220222152355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/02/2022] [Accepted: 01/17/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Valproate is widely prescribed medication for the control of seizures in pediatric population. It has been reported to be an important implication for drug induced pancreatitis. A case of valproate induced acute pancreatitis operated as surgical abdomen has been reported here. CASE REPORT A 13-year-old child presented to the emergency department with severe pain and abdominal distension associated with vomiting and constipation for four days. The patient's care givers did not disclose any medication history. Based on clinical examination and ultrasonography that revealed mild free fluid, provisional diagnosis of pyoperitoneum with peritonitis was made. An emergency exploratory laparotomy was undertaken during which acute pancreatitis was diagnosed intra-operatively. On further enquiry the caregiver revealed the history of valproate intake for last six months for generalized tonic‑clonic seizures. Valproate was discontinued and there was complete resolution of symptoms. CONCLUSION Both clinicians as well as care givers of paediatric patients receiving valproate should be watchful regarding this possible life-threatening complication to avoid delay in diagnosis and appropriate management.
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Affiliation(s)
- Vikramaditya Chauhan
- Department of General Surgery Kalpana Chawla Government Medical College, Karnal India
| | - Munish Sharma
- Department of General Surgery Kalpana Chawla Government Medical College, Karnal India
| | - Ajita Kapur
- Department of Pharmacology Vallabhbhai Patel Chest Institute, Delhi India
| | - Gulshan Kumar Garg
- Department of General Surgery Kalpana Chawla Government Medical College, Karnal India
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Abstract
Drug-induced pancreatitis is a disease that is receiving increasing attention. This article reviews the advances in the incidence, risk factors, pathogenesis, diagnosis, treatment and prevention of drug-induced pancreatitis by reviewing the literature on drug-induced pancreatitis, especially in the literature of the latest 10 years. The incidence of drug-induced pancreatitis is relatively low, however, there is an increasing trend with the widespread use of drugs, and the incidence seems to be related to regional distribution. There is currently lack of data on the epidemiology of drug-induced pancreatitis in China. In recent years, research on the pathogenesis of drug-induced pancreatitis has made some progress, but further research is needed. Drug-induced pancreatitis is a diagnosis of exclusion. With further understanding and research, a new diagnostic approach has been proposed. Pharmacogenomics is expected to help prevent and perform an individual treatment of drug-induced pancreatitis.
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