Mirtazapine-associated acute pancreatitis in a patient with insomnia and co-occurring psychiatric disorders

Abstract

We report the case of an African American patient who developed drug-associated acute pancreatitis without hypertriglyceridemia, after being treated with mirtazapine for major depressive disorder (MDD). Acute pancreatitis is characterized by rapid inflammation and autodigestion of the pancreas, which may become life-threatening. Although heavy alcohol use and gallstones are the most common causes of acute pancreatitis, some medications are also known to cause drug-induced acute pancreatitis. This report describes a 47-year-old African American female with a history of MDD, insomnia, posttraumatic stress disorder (PTSD), and alcohol use disorder, who was prescribed mirtazapine. A literature search implicated mirtazapine as a rare cause of drug-induced acute pancreatitis. Some reports have suggested that mirtazapine-associated acute pancreatitis may be due to hypertriglyceridemia. This case report instead presents with a normal lipid panel, which is consistent with the majority of prior reports, and it is noteworthy for introducing an alternative mechanism. The Naranjo Adverse Drug Reaction (ADR) Probability Scale calculated an ADR of 5, indicating mirtazapine as the probable cause of the patient's drug-associated acute pancreatitis.