Acute pancreatitis and olanzapine–valproate association: A pilot study

Introduction Drugs are responsible for 0.1–2% of acute pancreatitis incidents, which is characterized by the onset of parenchymal fat necrosis with inflammation in a previously healthy individual (Jones, 2015). Elevation of serum amylase is an effective marker of disease (de Berardinis, 1999). Valproic acid induces acute pancreatitis as a direct toxic effect of free radicals on the pancreatic tissue (Kaurich, 2008). Most cases of pancreatitis occurred within 6 months after the start of therapy with one or more antipsychotic agents (Koller, 2003). The temporal relationship of the onset of pancreatitis with the start of drug therapy further supports a cause-and-effect relationship (Alonso-Alonso, 2006). Some clinical reports noticed sporadic acute pancreatitis in patients taking both valproate and olanzapine. Methods We selected 50 psychiatric inpatients taking both olanzapine and valproate, presenting acute and aspecific gastroenteric symptomatology. We measured out their serum amylase and the time between drug prescription and start of gastroenteric simptomatology. Results and conclusions A large part of subjects associated olanzapine and valproate over 6 months before gastroenteric symptoms would start. Elevation of serum amylase rates does not suggest a link between this drug association and acute pancreatitis. Meanwhile, larger populations surveys could be helpful in early detecting sporadic cases.