Exenatide
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First report of necrotising pancreatitis: case report A 54-year-old man developed acute necrotising pancreatitis while receiving exenatide for diabetes. Three months after initiating exenatide 5µg twice daily, the man presented with a 1-day history of abdominal pain and vomiting, diabetic ketoacidosis and pancreatitis. He had been started on exenatide 1 year earlier, but had discontinued shortly thereafter. At the time of presentation he was also receiving lisinopril and insulin glargine. Laboratory examination revealed an amylase level of 1431 U/L, a lipase level of 6863 U/L, a triglyceride level of 90 mg/dL and a glucose level of 656 mg/dL. Liver enzyme levels were ALT 55 U/L, AST 67 U/L, total bilirubin 4 mg/dL, direct bilirubin 3.6 mg/dL and ALP 144 U/L. His calcium level was 9.5 mg/dL. An abdominal CT revealed necrotising pancreatitis around the pancreatic tail and evidence of right portal vein thrombosis. An ultrasound indicated that his common bile duct was dilated. The man underwent debridement of his pancreas. Eleven days after the operation, he was extubated and discharged shortly afterwards. On discharge, all of this medications were reinstated except for exenatide. A CT scan peformed 6 weeks later revealed residual inflammation at the pancreatic tail. Author comment: "Due to the lack of clear evidence supporting other causative etiologies of pancreatitis, recent reports of pancreatitis associated with exenatide, as well as the relative proximity of the medication administration, leads us to believe the likely etiology of this patient’s condition was related to exenatide." Kawji H, et al. Acute necrotizing pancreatitis in a patient taking exenatide (Byetta). 90th Annual Meeting of the Endocrine Society : abstr. P1-322, 15 Jun 801114683 2008. - USA
» Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of necrotising pancreatitis associated with exenatide. The WHO Adverse Drug Reactions database contained 37 reports of pancreatitis and one report of necrosis associated with exenatide.
0114-9954/10/1208-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 28 Jun 2008 No. 1208
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