Pravastatin and Acute Pancreatitis - A Rare Association

Abstract

Purpose: Introduction: Approximately two percent of acute pancreatitis (AP) cases are drug induced. Statins are identified as a rare cause and the literature on statin induced AP is based only on case reports. Simvastatin, Rosuvastatin, Atorvastatin, Fluvastatin and Lovastatin have been implicated so far, with only one case of Pravastatin cited as a potential cause. We report the only case of Pravastatin induced AP confirmed by a rechallenge, which is considered to be the gold standard to diagnose any drug related adverse effect. Case Description: A 73 yr old African-American female presented with acute abdominal pain secondary to acute pancreatitis. Her past medical history was significant for AP five years ago, while taking 40 mg of Atorvastatin per day. At that time most causes of acute pancreatitis were ruled out by a thorough history and evaluation including absence of alcohol intake, normal serum triglycerides and a negative imaging work up for biliary disease on ERCP, leaving Atorvastatin as the most likely causative agent. Four years later, due to high cholesterol levels, she was started on Pravastatin 10 mg, which was tolerated well. Eight months later, for a better lipid profile, the dose was increased to 40 mg daily. Two months after the dose increment, the patient developed AP, confirmed on CT abdomen, elevated pancreatic enzymes with a negative work up again for all other common etiologies. The pancreatitis resolved with conservative management and withdrawal of Pravastatin. Discussion: Statins are reported as a rare cause of AP; the exact incidence and underlying mechanism remain obscure. Our case substantiates the causative association and supports the theory of statin induced pancreatitis as a class effect. Interestingly, our case also suggests a probable role of the dosage of statins as a crucial factor. Based on our literature review, no such dose related reports have been found. It has been noted that AP can develop within days to months of initiating statin therapy. Clinicians should have a high index of suspicion for diagnosing AP in patients on statin therapy, in appropriate clinical context. Further research and clinical studies are needed to understand this rare complication of a commonly used class of drugs.