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首页> 外文期刊>The Journal of pharmacy technology: jPT : official publication of the Association of Pharmacy Technicians >Metformin-Associated Exacerbation of Chronic Pancreatitis: A Possible Adverse Drug-Disease Interaction
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Metformin-Associated Exacerbation of Chronic Pancreatitis: A Possible Adverse Drug-Disease Interaction

机译：二甲双胍相关的慢性胰腺炎加重：可能的不良药物-疾病相互作用。

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Objective: To report a case of metformin-associated exacerbation of chronic pancreatitis and examine this possible drug-disease interaction.Case Summary: A 59-year-old woman with chronic pancreatitis (CP) experienced a severe exacerbation of her characteristic chronic abdominal pain 3 weeks after initiation and titration of metformin therapy; the exacerbation resolved upon discontinuation of metformin. The patient presented to the emergency department experiencing nausea and severe right upper quadrant abdominal pain with radiation to the right flank. Persistent abdominal pain, which had been a primary feature of CP, was previously mild and easily controlled with oral analgesics. Laboratory studies ruled out acute pancreatitis and were significant only for elevated glucose (168 mg/dL). Subsequently, she was given intravenous pain and nausea medications and discharged to home. The pain and nausea shortly returned and continued for 3 more days, at which point she telephoned her gastroenterologist, who advised that she discontinue metformin because of possible adverse reaction. Within a few days of discontinuing metformin, the nausea resolved and abdominal pain gradually returned to baseline level.Discussion: Metformin is not generally known to cause or exacerbate pancreatitis, although cases of acute pancreatitis associated with metformin therapy have been reported in the literature. No cases involving chronic pancreatitis have been reported. Consequently, metformin's prescribing guidelines do not contain precautions or contraindications for patients with chronic pancreatitis. Use of the Naranjo probability scale for assessment of this case revealed that the adverse drug effect was possible, reflecting the symptomatic resolution upon discontinuation while accounting for the lack of causative certainty, previous conclusive case reports, as well as the presence of possible nondrug causes.Conclusions: To our knowledge, this is the first case describing metformin-associated exacerbation of chronic pancreatitis. Although this occurrence may be rare, cautionary consideration, education, and monitoring should accompany initiation of metformin therapy in select patients with chronic pancreatitis.
机译：目的：报告一例与二甲双胍相关的慢性胰腺炎加重病例，并研究这种可能的药物-疾病相互作用。案例摘要：一名59岁的慢性胰腺炎（CP）妇女经历了其特征性慢性腹痛的严重加重3二甲双胍治疗开始和滴定后数周;加用二甲双胍后病情加重。该患者出现在急诊科，经历了恶心和严重的右上腹腹痛，并向右胁腹放射。持续性腹痛是CP的主要特征，以前是轻度的，并且可以通过口服镇痛药轻松控制。实验室研究排除了急性胰腺炎，并且仅对血糖升高（168 mg / dL）有意义。随后，给她静脉注射止痛药和恶心药物，然后出院回家。疼痛和恶心不久后恢复并持续了三天，这时她打电话给肠胃科医生，她建议她因为可能的不良反应而停用二甲双胍。停用二甲双胍后的几天内，恶心得到缓解，腹痛逐渐恢复至基线水平。讨论：尽管文献中已经报道了与二甲双胍治疗有关的急性胰腺炎病例，但通常不知道二甲双胍可引起或加重胰腺炎。没有报道涉及慢性胰腺炎的病例。因此，二甲双胍的处方指南不包含对慢性胰腺炎患者的预防措施或禁忌症。使用Naranjo概率量表评估该病例表明，可能出现药物不良反应，这反映了停药后的对症解决，同时考虑到缺乏病因确定性，先前的确凿病例报告以及可能存在的非药物原因。结论：据我们所知，这是描述二甲双胍相关慢性胰腺炎加重的首例病例。尽管这种情况可能很少见，但对于某些慢性胰腺炎患者，开始二甲双胍治疗时应谨慎考虑，教育和监测。

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