isotretinoin and Pancreatitis

Monitoring of triglycerides for patients on isotretinoin is practised primarily to avoid hypertriglyceridaemia-associated pancreatitis. The aim of this study was to describe clinically the published cases of hypertriglyceride-associated pancreatitis. A comprehensive search strategy using MEDLINE, Embase and grey literature was conducted (1960 to January 2016) to identify all case reports of isotretinoin-associated pancreatitis and all relevant studies of isotretinoin and triglycerides for any indication (≥ 20 patients). Terms related to isotretinoin, triglycerides and pancreatitis were searched with all available synonyms. Any studies that used isotretinoin and mentioned triglycerides or pancreatitis were searched in full text, where available, for cases of pancreatitis. Studies from all countries and published in any language were included, but Korean and Turkish studies could not be analysed. Two authors independently reviewed the publications to determine eligibility, and for data extraction. In total, 125 papers fulfilled the inclusion criteria and were searched for cases of pancreatitis. Eleven papers with 25 cases of pancreatitis associated with isotretinoin were identified; four of these cases were likely due to hypertriglyceridaemia. Three patients had elevated baseline triglycerides, but no monitoring. Pancreatitis occurred 6 and 7 weeks, and 6 months after initiation of therapy. For the fourth patient who was treated for glioblastoma and died, no detailed clinical information was available. Idiosyncratic pancreatitis associated with isotretinoin is the most frequent pancreatitis on isotretinoin, and patients should be warned about it. Hypertriglyceride-associated pancreatitis is an exceedingly rare adverse event of isotretinoin therapy. Our data cannot give a frequency or risk for either adverse event. Based on the clinical information of the patients available, we conclude that for patients without elevated baseline triglycerides, or risk thereof, monitoring of triglycerides during therapy is of little value.

Topics: Adolescent; Adult; Aged; Biomarkers; Female; Humans; Hypertriglyceridemia; Isotretinoin; Male; Pancreatitis; Triglycerides

Topics: Etretinate; Humans; Hyperlipidemias; Isotretinoin; Kinetics; Lipid Metabolism; Lipoproteins; Pancreatitis; Retinoids

Topics: Acne Vulgaris; Acute Disease; Adolescent; Dermatologic Agents; Humans; Isotretinoin; Male; Pancreatitis

Topics: Abdominal Pain; Acute Disease; Adolescent; Adult; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Pancreatitis; Risk Factors; Young Adult

Topics: Drug-Related Side Effects and Adverse Reactions; Humans; Isotretinoin; Pancreatitis; Pharmaceutical Preparations

A 19-year-old female patient is presented who was taking isotretinoin for severe, nodulocystic acne. She subsequently developed abdominal pain during the course of treatment, thought to be related to an adverse reaction to the medication. A concerning side effect of isotretinoin is hypertriglyceridemia, which may be a cause of pancreatitis. A lipase level was determined to be elevated in this case. The patient was diagnosed with acute pancreatitis and the offending agent was discontinued. Clinicians need to be aware of the side effects when prescribing isotretinoin for recalcitrant acne.

Topics: Abdominal Pain; Acne Vulgaris; Acute Disease; Adult; Dermatologic Agents; Female; Humans; Isotretinoin; Lipase; Pancreatitis; Triglycerides

Isotretinoin is a vitamin-A derivative most commonly utilized in the treatment of severe recalcitrant nodulocystic acne. Derangement of lipid metabolism leading to increased triglyceride and cholesterol level has been reported after taking this drug. We report the case of a 43-year-old female with no identifiable risk factor for pancreatitis who developed acute pancreatitis associated with hyperlipidemia while being treated with isotretinoin for hidradenitis suppurativa. To our knowledge, this is the third reported case of isotretinoin-induced hyperlipidemia leading to acute pancreatitis.

Topics: Acute Disease; Adult; Female; Hidradenitis Suppurativa; Humans; Hyperlipidemias; Isotretinoin; Pancreatitis

A 17 year-old young man developed two episodes of acute pancreatitis, separated by a 2 year interval and associated with isotretinoin therapy. In 1989, vesicular sludge without lithiasis was evidenced and in 1991, gall bladder stones were found by cholecystectomy. Concomitantly, transient dysfibrinogenemia and thrombopenia were present. It is interesting to note that far away from the use of isotretinoin, the patient suffered from another episode of acute pancreatitis without any coagulation disorder. The involvement of Roaccutane in cellular differentiation is discussed as well as its causal association with acquired dysfibrinogenemia and transient thrombocytopenia.

Topics: Acute Disease; Adolescent; Fibrinogens, Abnormal; Humans; Isotretinoin; Keratolytic Agents; Male; Pancreatitis; Recurrence; Thrombocytopenia

Isotretinoin, a retinoid derivative, is in wide use as a treatment for severe acne and other dermatologic conditions. Its effects on serum lipids, most notably the induction of hypertriglyceridemia, have been well documented. We present a case of a young woman with a previous history of gestational hyperlipidemia who developed hypertriglyceridemia and pancreatitis after initiation of isotretinoin therapy. A history of gestational hyperlipidemia may serve as a marker to help identify patients who are at increased risk for developing severe hypertriglyceridemia while receiving isotretinoin. Her case emphasizes the need to consider the possibility of pancreatitis in patients who develop abdominal pain while receiving this drug.

Topics: Abdominal Pain; Acne Vulgaris; Adult; Female; Humans; Hypertriglyceridemia; Isotretinoin; Pancreatitis

Topics: Adult; Estrogens, Conjugated (USP); Female; Humans; Hyperlipidemias; Isotretinoin; Pancreatitis; Plasmapheresis; Tretinoin; Triglycerides