Escitalopram Induced Pancreatitis: An Unusual Culprit

Abstract

Drug-induced pancreatitis accounts for 3-5% of all cases of acute pancreatitis. Over 12% of US adolescents and adults use antidepressants. We hereby report a case of acute Escitalopram-induced non-necrotizing pancreatitis in a 27-year-old male complaining of epigastric pain. He had no family history of pancreatitis or pancreatic cancer, and reported drinking less than 2 alcoholic drinks weekly. His only medication was Escitalopram, which he started 2 weeks prior for panic disorder and denied any supplement use. His diagnostic evaluation revealed (a)A normal CBC and kidney function (b)Serum lipase of 1746 U/L (c) Abdomen CT-scan with no pancreatic masses and evidence of acute pancreatitis(d) Absence of gallstones, biliary sludge or CBD dilation on ultrasound (e)Normal serum glucose,calcium and triglyceride levels (f)Normal IgG and IgG subclass levels. Intravenous hydration was initiated, and Escitalopram was discontinued with complete symptom resolution in 4 days. No re-challenge was performed. A Naranjo adverse drug reaction score was 6 suggesting a probable reaction given no previous reports on Escitalopram. Three cases of sertraline-induced pancreatitis have been reported in the literature with a latency period of a few days to 4 weeks reported [1,2]. A population study in Taiwan suggest a class effect given an association between recent SSRI use and risk of acute pancreatitis [3]. This wasn't re-demonstrated in a different population cohort in Sweden, however, a much longer latency period was studied which is inconsistent with the reported cases [4]. Further research and population studies are required to better characterize the risk of drug-induced acute pancreatitis with SSRI use, given the high prevalence of use of these agents and the significant morbidity with this adverse effect.