sulindac and Pancreatitis

Topics: Acute Disease; Aged; Arthritis, Rheumatoid; Humans; Male; Pancreatitis; Sulindac

Topics: Acute Disease; Aged, 80 and over; Antihypertensive Agents; Disease Progression; Female; Humans; Hydrochlorothiazide; Lisinopril; Magnetic Resonance Imaging; Pancreatitis; Pancreatitis, Chronic; Sulindac; Tomography, X-Ray Computed

Two women, aged 91 and 46 years respectively, developed acute pancreatitis following treatment with sulindac (Clinoril) for five weeks in the one case and four and a half years in the other. The oldest patient became acutely ill. An emergency laparotomy was performed which showed considerable pancreatic edema and typical fat necroses. The other case presented a more protracted course and was not operated. Restitution was remarkably quick in both patients after cessation of the sulindac treatment.

Topics: Acute Disease; Aged; Female; Humans; Middle Aged; Pancreatitis; Sulindac

Two patients with sulindac-induced acute pancreatitis presented clinically with abdominal pain, right upper-quadrant tenderness, markedly increased serum amylase values, and hyperbilirubinemia, findings initially suggestive of gallstone pancreatitis. Ultrasound examinations were negative for gallstones. One patient was inadvertently treated two years later with sulindac with recurrence of abdominal pain, marked hyperamylasemia, and jaundice. Clinical resolution was rapid with each episode following discontinuation of sulindac.

Topics: Acute Disease; Aged; Cholelithiasis; Female; Humans; Indenes; Male; Pancreatitis; Sulindac

A 68-year-old man without previous hepatobiliary or pancreatic disease was admitted after five attacks of nausea, vomiting, abdominal pain and high fever. Laboratory investigations indicated cholestatic liver disease and pancreatitis. For 1.5 years the patient had occasionally been taking a non-steroidal anti-inflammatory drug, sulindac (clinoril, MSD, New York), for osteoarthritis. On suspicion of a drug-associated disease, a rechallenge experiment was performed with sulindac. Five hours after drug administration symptoms recurred. There was a pronounced increase in serum alkaline phosphatase and amylase. A liver biopsy 3 d later showed portal tract inflammatory infiltration and abnormal interlobular bile ducts with degeneration and necrosis of the epithelium and neutrophilic infiltration of the ducts. Sulindac-induced cholangitis has not been described previously. The pathogenetic mechanism is considered to be an immunoallergic idiosyncratic reaction to the active metabolite of sulindac absorbed by the bile duct epithelium. The lesion is apparently reversible.

Topics: Acute Disease; Aged; Biopsy; Cholangitis; Humans; Indenes; Liver; Male; Pancreatitis; Sulindac

Topics: Acute Disease; Adult; Arthritis, Juvenile; Female; Humans; Indenes; Pancreatitis; Sulindac

Topics: Aged; Fat Necrosis; Female; Humans; Indenes; Necrosis; Pancreatitis; Skin Diseases; Sulindac

ADRs in the elderly may present in an atypical manner. Atypical reactions are uncommon and usually cannot be anticipated from the chemical or pharmacologic properties of the drug. In many cases, you may find a careful and thorough drug history and knowledge of drug-related reactions more helpful than an array of laboratory data.

Topics: Acetazolamide; Aged; Anemia, Hemolytic; Bromocriptine; Captopril; Chlorpropamide; Cimetidine; Clonidine; Dienestrol; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Hydralazine; Lung Diseases; Male; Middle Aged; Nitrofurantoin; Pancreatitis; Papaverine; Peripheral Nervous System Diseases; Procainamide; Propranolol; Sulindac; Theophylline; Timolol

We report 2 patients who had serious adverse effects after taking sulindac. One of these patients developed toxic hepatitis and Stevens-Johnson/toxic epidermal necrolysis syndrome which resulted in death. Such fatal reaction to sulindac therapy has not been reported previously. There was temporal relation of ingestion of sulindac to 2 episodes of acute pancreatitis in the 2nd patient, strongly suggesting drug induction. Recent reports of similar side effects with other nonsteroidal antiinflammatory drugs suggest that these drugs may have potentially more serious toxicity than has been recognized.

Topics: Acute Disease; Arthritis, Rheumatoid; Back Pain; Chemical and Drug Induced Liver Injury; Female; Humans; Indenes; Middle Aged; Pancreatitis; Stevens-Johnson Syndrome; Sulindac

Topics: Aged; Female; Humans; Indenes; Pancreatitis; Sulindac

Topics: Arthritis; Female; Humans; Indenes; Middle Aged; Pancreatitis; Sulindac

Topics: Aged; Female; Humans; Indenes; Pancreatitis; Sulindac

Topics: Acute Disease; Aged; Female; Humans; Indenes; Pancreatitis; Sulindac