Angiotensin-Converting Enzyme (ACE) Inhibitors and Pancreatitis: A Potential Dose-dependent Relationship
  • Murtaza Hussain
    Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, MI, USA
  • Smit S Deliwala
    Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, MI, USA
  • Anoosha Ponnapalli
    Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, MI, USA
  • Viraj Modi
    New York Institute of Technology College of Osteopathic Medicine, Glen Head, NY, USA
  • Ashok Kanugula
    Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, MI, USA
  • Mamoon M Elbedawi
    Department of Internal Medicine – Division of Gastroenterology, Michigan State University at Hurley Medical Center, Flint, MI, USA
  • Ghassan Bachuwa
    Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, MI, USA

Keywords

Acute pancreatitis, drug-induced pancreatitis, ACEi, recurrent acute pancreatitis, lisinopril

Abstract

Acute pancreatitis (AP) remains one of the most common causes of emergency department visits in the USA. The literature supports an association between angiotensin-converting enzyme inhibitors (ACEi), mainly at steady-state doses, and AP. We present a case of recurrent AP and pseudocyst formation following multiple ACEi dose adjustments after a steady-state period lasting for over a decade. Previous reports have rarely described ACEi-induced pancreatitis and pseudocyst development. ACEi can cause significant ductal obstruction and fluid retention due to its angioedema effects. Consequently, it may trigger AP complicated by pseudocyst formation. Therefore, ACEi administration must be considered in the appropriate clinical context.

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References

  • Thumma S, Errico K, Manchala V, Mattana J. Lisinopril-induced acute pancreatitis. Am J Ther 2019;26(4):e555–e558.
  • Dabaghi S. ACE inhibitors and pancreatitis. Ann Intern Med 1991;115(4):330–331.
  • Mahmoudpour SH, Asselbergs FW, Souverein PC, de Boer A, Maitland-van der Zee AH. Prescription patterns of angiotensin-converting enzyme inhibitors for various indications: a UK population-based study. Br J Clin Pharmacol 2018;84(10):2365–2372.
  • Singh S. Angiotensin-converting enzyme (ACE) inhibitor-induced acute pancreatitis: in search of the evidence. South Med J 2006;99(12):1327–1329.
  • Kuoppala J, Enlund H, Pulkkinen J, Kastarinen H, Jyrkkä J, Happonen P, et al. ACE inhibitors and the risk of acute pancreatitis—a population-based case–control study. Pharmacoepidemiol Drug Saf 2017;26(7):853–857.
  • Kanbay M, Selcuk H, Yilmaz U, Boyacioglu S. Recurrent acute pancreatitis probably secondary to lisinopril. South Med J 2006;99(12):1388–1390.
  • Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 2012;143(5):1179–1187.
  • Eland IA, Sundström A, Velo GP, Andersen M, Sturkenboom MCJM, Langman MJS, et al. Antihypertensive medication and the risk of acute pancreatitis: the European case-control study on drug-induced acute pancreatitis (EDIP). Scand J Gastroenterol 2006;41(12):1484–1490.
  • Gershon T, Olshaker JS. Acute pancreatitis following lisinopril re-challenge. Am J Emerg Med 1998;16(5):523–524.
  • Tosun E, Oksuzofflu B, Topalofflu O. Relationship between acute pancreatitis and ACE inhibitors. Acta Cardiol 2004;59(5):571–572.
  • Gorsane I, Ayed TB, Aoudia R, Kaaroud H, Hamida FB, Harzallah A, et al. Simultaneous acute pancreatitis and angioedema associated with angiotensin-converting enzyme inhibitor. Saudi J Kidney Dis Transpl 2019;306):1479–1484.
  • Bouffard L, Papirakis M-E, Maheux P. Enalapril increases the local extravasation of macromolecules and nitric oxide synthase in pancreas of the fructose-fed insulin-resistant rat model. Pancreas 2006;33(4):418–424.
  • Jones MR, Hall OM, Kaye AM, Kaye AD. Drug-induced acute pancreatitis: a review. Ochsner J 2015;15(1):45–51.
  • Brown KV, Khan AZ, Paterson IM. Lisinopril-induced acute pancreatitis. J R Army Med Corps 2007;153(3):191–192.
  • Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30(2):239–245.
  • Badalov N, Baradarian R, Iswara K, Li J, Steinberg W, Tenner S. Drug-induced acute pancreatitis: an evidence-based review. Clin Gastroenterol Hepatol 2007;5(6):648–661.
  • Habashi S, Draganov PV. Pancreatic pseudocyst. World J Gastroenterol 2009;15(1):38.
  • Anagnostopoulos GK, Kostopoulos P, Tsiakos S, Margantinis G, Arvanitidis D. Fulminant pancreatitis associated with ramipril therapy. Pancreas 2003;27(3):278–279.
  • Standridge JB. Fulminant pancreatitis associated with lisinopril therapy. South Med J 1994;87(2):179–181.
  • Bexelius TS, Ljung R, Mattsson F, Lu Y, Lindblad M. Angiotensin II receptor blockers and risk of acute pancreatitis-a population based case–control study in Sweden. BMC Gastroenterol 2017;17(1):36.

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    Published: 2020-10-28
    Issue: 2020: Vol 7 No 12 (view)

    How to cite:
    1.
    Hussain M, Deliwala SS, Ponnapalli A, Modi V, Kanugula A, Elbedawi MM, Bachuwa G. Angiotensin-Converting Enzyme (ACE) Inhibitors and Pancreatitis: A Potential Dose-dependent Relationship. EJCRIM 2020;7 doi:10.12890/2020_001956.