Acute Pancreatitis Following Orlistat Therapy: Report of Two Cases

  • Faheem Asem Ahmad Department of General Surgery, Hairmyres Hospital. East Kilbride, United Kingdom
  • Sajid Mahmud Department of General Surgery, Hairmyres Hospital. East Kilbride, United Kingdom
Keywords: Drug Toxicity, orlistat, Pancreatitis, Acute Necrotizing

Abstract

Context Orlistat is a pancreatic lipase inhibitor licensed for the treatment of obesity. As obesity rates increase and non-prescription dispensing of orlistat increases, an awareness of its adverse effects is of crucial importance as complications arise more frequently from increased use. Orlistat induced pancreatitis has been described only once previously, but without a diagnostic increase in serum amylase. Case report We report the case of two patients who developed severe acute abdominal pain and elevated pancreatic enzymes at 2 and 10 days after starting orlistat. In one case no alterative precipitant was identified. In the other, a predisposing history of pancreatic injury was present. In both cases all other contributory causes were excluded. Conclusions Our reports suggest orlistat can trigger drug induced acute pancreatitis in certain patients. For patients presenting with abdominal pain soon after commencing orlistat, a diagnosis of pancreatitis must be considered. We also recommend cautious use of orlistat in patients at risk of pancreatic injury.

Image: Orlistat (Author: Boghog; Wikimedia Commons).

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References

Whitcomb DC. Clinical practice. Acute pancreatitis. N Engl J Med 2006; 354:2142-50. [PMID 16707751 ] (FULL TEXT: http://content.nejm.org/cgi/content/full/354/20/2142)

Wilmink T, Frick TW. Drug-induced pancreatitis. Drug Saf 1996; 14:406-23. [PMID 8828018 ] (FULL TEXT: http://adisonline.com/drugsafety/Abstract/1996/14060/Drug_Induced_Pancreatitis.6.aspx)

Napier S, Thomas M. 36 year old man presenting with pancreatitis and a history of recent commencement of Orlistat case report. Nutr J 2006; 5:19. [PMID 16938137 ] (FULL TEXT: http://www.nutritionj.com/content/5/1/19)

UK Working Party on Acute Pancreatitis. UK guidelines for the management of acute pancreatitis. Gut 2005; 54 S3:1-9. [PMID 15831893 ] (FULL TEXT: http://gut.bmj.com/content/54/suppl_3/iii1.long)

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; 30:239-45. [PMID 7249508 ] (FULL TEXT: http://www.nature.com/clpt/journal/v30/n2/pdf/clpt1981154a.pdf)

Proietto J, Fam BC, Ainslie DA, Thorburn AW. Novel anti-obesity drugs. Expert Opin Investig Drugs 2000; 9:1317-26. [PMID 11060745 ] (FULL TEXT: http://informahealthcare.com/doi/pdf/10.1517/13543784.9.6.1317)

National Institute for Clinical Excellence. Obesity guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. Clinical Guideline 43. London: NICE, 2006. (FULL TEXT: http://guidance.nice.org.uk/CG43)

Guerciolini R. Mode of action of orlistat. Int J Obes Relat Metab Disord 1997; 21:S12-23. [PMID 9225172]

Zhi J, Melia AT, Eggers H, Joly R, Patel IH. Review of limited systemic absorption of orlistat, a lipase inhibitor, in healthy human volunteers. J Clin Pharmacol 1987; 35:1103-8. [PMID 8626884 ] (FULL TEXT: http://jcp.sagepub.com/cgi/reprint/35/11/1103)

Caner M, Dogruman H, Taskin E, Kandil A, Demirci C. Effects of orlistat and its relationship with nitric oxide in the small intestinal mucosa. Chin J Physiol 2005; 48:217-22. [PMID 16548424 ] (FULL TEXT: http://www.ceps.com.tw/ec/ecjnlarticleView.aspx?jnlcattype=1&jnlptype=5&jnltype=44&jnliid=941&issueiid=23644&atliid=280874)

Filippatos TD, Derdemezis CS, Gazi IF, Nakou ES, Mikhailidis DP, Elisaf MS. Orlistat-associated adverse effects and drug interactions: a critical review. Drug Saf 2008; 31:53-65. [PMID 18095746 ] (FULL TEXT: http://adisonline.com/drugsafety/Fulltext/2008/31010/Orlistat_Associated_Adverse_Effects_and_Drug.5.aspx)

Kim DH, Lee EH, Hwang JC, Jeung JH, Kim do H, Cheong JY, et al. A case of acute cholestatic hepatitis associated with orlistat [in Korean]. Taehan Kan Hakhoe Chi 2002; 8: 317-20. [PMID 12499790 ] (FULL TEXT: http://www.kasl.org/english/view.asp?year=2002&page=317&vol=8&iss=3#)

Montero JL, Muntane J, Fraga E, Delgado M, Costán G, Serrano M, et al. Orlistat associated subacute hepatic failure. J Hepatol 2001; 34:173. [PMID 11211898 ] (FULL TEXT: http://www.jhep-elsevier.com/article/PIIS0168827800000428/fulltext)

Thurairajah PH, Syn WK, Neil DA, Stell D, Haydon G. Orlistat (Xenical)-induced subacute liver failure. Eur J Gastroenterol Hepatol 2005; 17:1437-8. [PMID 16292105 ] (FULL TEXT: http://journals.lww.com/eurojgh/Citation/2005/12000/Orlistat__Xenical__induced_subacute_liver_failure.30.aspx)

Lau G, Chan CL. Massive hepatocellular [correction of hepatocullular] necrosis: was it caused by Orlistat? Med Sci Law 2002; 42:309-12. [PMID 12487515]

Torgerson J, Hauptman J, Boldrin M, Sjöström L. XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 2004; 27:155-61. [PMID 14693982 ] (FULL TEXT: http://care.diabetesjournals.org/content/27/1/155.long)

Davidson MH, Hauptman J, DiGirolamo M, Foreyt JP, Halsted CH, Heber D, et al. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: a randomized controlled trial. JAMA 1999; 281:235-42. [PMID 9918478 ] (FULL TEXT: http://jama.ama-assn.org/cgi/content/full/281/3/235)

British Medical Association and Royal Pharmaceutical Society of Great Britain. British National Formulary, 58 ed. London: UK, 2009. (FULL TEXT: http://bnf.org/bnf/not_eligible.htm)

GlaxoSmithKline. GlaxoSmithKline receives European Commission approval to market alli (orlistat 60mg).[online]. Issued: Wednesday 21 January 2009, London UK. (FULL TEXT: http://www.gsk.com/media/pressreleases/2009/2009_pressrelease_10011.htm)

FDA: US Food and Drug Administration. FDA approves orlistat for over-the-counter use [online]. FDA News Release: February 7, 2007; P07-15. (FULL TEXT: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108839.htm)

Orlistat
Published
2016-07-13
How to Cite
AhmadF., & MahmudS. (2016). Acute Pancreatitis Following Orlistat Therapy: Report of Two Cases. JOP. Journal of the Pancreas, 11(1), 61-63. https://doi.org/10.6092/1590-8577/3874
Section
CASE REPORTS