Contemporary review of drug-induced pancreatitis: A different perspective

Table 1 Classification system of drug-induced acute pancreatitis according to Badalov et al[11]

	Definition	Example
Class I drug	Ia: at least one case report, evidence of a positive re-challenge, and exclusion of other causes of AP	Codeine, cytarabine, dapsone, enalapril, furosemide, isoniazid, mesalamine, metronidazole, pentamidine, pravastatin, procainamide, simvastatin, sulfamethoxazole, sulindac, tetracycline, valproic acid
	Ib: similar to class Ia, except that other causes of AP could not be ruled out	Amiodarone, azathioprine, dexamethasone, ifosfaide, lamivudine, losartan, 6-MP, premarin, TMP-SMZ
Class II drugs	Include at least four case reports with a consistent latency period for at least 75% of the cases	Acetaminophen, Clozapine, DDI, erythromycin, estrogen, l-asparaginase, propofol, tamoxifen
Class III drug	At least two case reports but do not have re-challenge data or a consistent latency period	Alendronate, carbamazepine, ceftriaxone, clarithromycin, cyclosporin, hydrochlorothiazide, interferone/ribavirin, metformin, minocycline, naproxen, paclitaxel, prednisone, prednisolone
Class IV drug	One case report without re-challenge data	Ampicillin, cisplatin, colchicine, cyclophosphamide, diclofenac, doxorubicin, interleukin-2, octreotide, propoxyphene, rifampin, risperidone, sertaline, tacrolimus, vincristine

AP: Acute pancreatitis; 6-MP: 6-mercaptopurine; TMP-SMZ: Trimethoprim and sulfamethoxazole.

Table 2 Mechanism of drug induced pancreatitis with drugs associated with acute pancreatitis

Mechanism of DIAP	Drugs with a definite relationship or with classI/II to AP	Probable	Similar structure/class/mechanism withreported cases
Structural	Cholestatic liver injury		Rofecoxib
	Azathioprine
	Cytarabine
	Spasm of the sphincter of Oddi	Octreotide	Opium
	Opioids		Marcolides
	Codeine
	Erythromycin
	Obstruction		ACE-inhibitors
	Enalapril-angioedema
	Duct constriction		NSAIDs
	Sulindac
	Stone		Ceftriaxone
			Dipyridamole
Toxins	Acetaminophen	Metformin	Minocycline
	Didanosine		Tigecycline
	Isoniazid		Doxycycline
	Metronidazole		NRTI
	Valproic acid		HMG-CoA reductase inhibitors
	Mesalamine
	Pentamidine
	Asparaginase
	Sitaliptin
	Exenatide
	Tetracycline
	Pravastatin
Metabolic	Hypertriglyceridemia	Hydrochlorothiazide	Isotretinoin
	Estrogens	Interferon alfa	Retinoid derivaties
	Corticosteroids	Propofol	Protease inhibitors
	Furosemide	Tamoxifen	Saw palmetto
	β-blocker		Ethacrynic acid
	Clomiphene		Anti-psychotics (aripiprazole, clozapine, olanzapine, quetiapine, risperidone)
	Hypercalcemia		IV calcium
			Vitamin D
Vascular			Contrast media - iopamidol Procainamide
Immune-mediated	Azathioprine/mercaptopurine sulfasalazine

AP: Acute pancreatitis; NRTI: Nucleoside reverse transcriptase inhibitor; NSAIDs: Nonsteroidal anti-inflammatory drugs.