POSSIBLE LOVASTATIN-INDUCED FATAL NECROTIZING PANCREATITIS
Sérgio de A Nishioka and Liliane Q Guedes

BACKGROUND: A few cases of statin-associated pancreatitis have been reported in the literature, mostly related to the use of simvastatin. Only 3 cases of pancreatitis associated with lovastatin have been recognized, with 2 of them possibly due to its interaction with gemfibrozil and erythromycin.

CASE REPORT: A 49-year-old woman, who had been receiving treatment for hypercholesterolemia with lovastatin 20 mg/d for about a month, was admitted to a hospital with a diagnosis of diarrhea and septic shock. She was later referred to another hospital where surgical diagnosis of necrotizing pancreatitis was made and died after prolonged hospitalization. This patient had no evidence of common risk factors to acute pancreatitis, such as biliary tract disease or alcohol use, but had moderate hyperlipidemia. Assessment of the likelihood of a causal relationship using the Naranjo probability scale suggested that the association between lovastatin and necrotizing pancreatitis in this case was probable or possible, depending on the rejection or acceptance of shock or use of ranitidine and ceftriaxone as alternative causes of pancreatitis.

DISCUSSION: There is some evidence that statins are rarely associated with acute edematous and necrotizing pancreatitis, by unknown mechanisms. This case report adds to the evidence that lovastatin is possibly 1 of such statins.

CONCLUSIONS: Lovastatin is a possible cause of pancreatitis. Prescribers of statins (particularly simvastatin and lovastatin) should take into account the possibility of acute pancreatitis in patients who develop abdominal pain within the first weeks of treatment with these drugs.

J Pharm Technol 2003;19:283-6.