Pancreatitis associated with simvastatin plus fenofibrate

• Published in: The Annals of pharmacotherapy Vol. 36; no. 2; pp. 275 - 279
• Main Authors: McDonald, KB, Garber, BG, Perreault, MM
• Format: Journal Article
• Language: English
• Published: Cincinnati, OH Harvey Whitney Books 01-02-2002; SAGE Publications; Whitney
• Subjects: Aged; Biological and medical sciences; Drug Therapy, Combination; Drug toxicity and drugs side effects treatment; Fatal Outcome; Fenofibrate - administration & dosage; Fenofibrate - adverse effects; Humans; Hyperlipidemias - drug therapy; Hypolipidemic Agents - adverse effects; Hypolipidemic Agents - therapeutic use; Male; Medical sciences; Pancreatitis, Acute Necrotizing - chemically induced; Pancreatitis, Acute Necrotizing - surgery; Pharmacology. Drug treatments; Simvastatin - administration & dosage; Simvastatin - adverse effects; Toxicity: digestive system; simvastatin; fenofibrate; pancreatitis; Human; Drug combination; Enzyme; Fibrate derivatives; Toxicity; Acute; Simvastatin; Pancreatitis; Oral administration; Enzyme inhibitor; Statin derivative; Case study; Fenofibrate; Chemotherapy; Treatment; Digestive diseases; Hydroxymethylglutaryl-CoA reductase; Oxidoreductases; Pancreatic disease; Antilipemic agent
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1345/aph.1A180

OBJECTIVE:
To report a case of acute necrotizing pancreatitis associated with simvastatin and fenofibrate use.
CASE SUMMARY:
A 70-year-old white man presenting with rapid onset of abdominal pain, nausea, and vomiting was diagnosed with acute pancreatitis. On bowel rest, his condition deteriorated secondary to systemic inflammatory response syndrome, and he was transferred to a tertiary hospital's intensive care unit (ICU). He had been taking fenofibrate for 1 year; 6 months prior to this admission, he had been taking simvastatin 3 days of the week and fenofibrate the other 4 days of the week. The pancreatic tissue became necrotic, requiring surgical debridement. After a hospital stay of 121 days, including multiple ICU admissions, the patient died secondary to a bowel perforation.
DISCUSSION:
Although idiopathic pancreatitis cannot be ruled out in this patient, no causes of pancreatitis were identified other than drug induced. Five cases of acute pancreatitis caused by simvastatin have been reported; no case reports were found for fenofibrate. The onset of pancreatitis relative to the duration of therapy with simvastatin supports this medication as a possible cause of the pancreatitis.
CONCLUSIONS:
Drug-induced pancreatitis is well established as an adverse effect of some medications, although most are substantiated only with case reports. Given the absence of other apparent causes, simvastatin and fenofibrate should be considered as possible causes of pancreatitis in this patient.