Acute pancreatitis due to simvastatin

A. Murinello¹, E. Pinheiro²

 

Resumo

A pancreatite causada por fármacos ocorre numa incidência de 1,4-2% dos casos de pancreatite aguda, e deve ser equacionada sempre que as causas habituais de pancreatite aguda forem excluídas. Na maioria dos casos a gravidade da pancreatite por fármacos é pequena. A pancreatite aguda induzida por estatinas tem sido reportada pouco frequentemente mas, face à existência de referências de casos de pancreatite aguda causadas pela maioria das estatinas em uso, parece razoável admitir que possa estar implicado um efeito de classe das estatinas no mecanismo fisiopatológico. O mecanismo é desconhecido, mas o uso concomitante doutros fármacos parece ser importante em alguns casos. Os autores apresentam um caso de uma doente com pancreatite relacionada com sinvastatina, aconselhando que em geral, todos os doentes com pancreatite aguda causada por estatinas deveriam abdicar definitivamente da utilização destes fármacos. Foi feita uma revisão acerca dos vários tipos de reacções adversas possíveis a fármacos, salientando-se a importância da disciplina da farmacovigilância e da documentação adequada de cada reacção, de molde a tentar-se evitar a tempo lesões causadas por fármacos. A decisão médica de utilização de qualquer fármaco deverá ser baseada na relação entre risco de prescrição de um fármaco e benefícios potenciais nos doentes, considerados individualmente.

 

Summary

The incidence of drug-induced pancreatitis represents 1.4-2% of all cases of acute pancreatitis, and should be considered whenever the usual causes of acute pancreatitis are excluded. The severity of drug-induced pancreatitis is low in the majority of cases. Statin induced pancreatitis has been reported rarely, but as there have been reports of cases of acute pancreatitis caused by most of the statins in medical use, the possibility of a statin class effect being implicated in the physiopathological mechanism seems reasonable. The mechanism is unknown, but the concomitant use of another drug appears to be important in some cases. The authors present a case of a probable/likely acute pancreatitis due to simvastatin, and recommend that in general, all patients with statin induced acute pancreatitis should discontinue the use of statins permanently. A review of the several types of adverse drug reactions is presented, together with comments on the importance of pharmacovigilance and accurate documentation of these reactions, so that injury can be prevented in time. The medical decision to use a particular drug must consider the risks of prescribing the drug against the potential benefits for each individual patients.

 

 

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Recebido para publicação: 26/09/2005

Aceite para publicação: 15/02/2006

 

 

(1) Division of Internal Medicine 1.

(2) Division of Pharmacy.

Hospital de Curry Cabral, Lisbon, Portugal.