Sultan Efsun TAMDEMİR, Bahadır GENİŞ, Selçuk ASLAN, B Harun KÜÇÜK

Valproik Asit, Olanzapin ve Risperidonun Birlikte Kullanımından Kaynaklanan Bir Akut Pankreatit Olgusu

Akut pankreatit (AP), pankreas dokusunun etkilendiği geri dönüşlü enflamatuar bir süreçtir. İlaca bağlı akut pankreatit gelişimi, tüm akut pankreatitlerin küçük bir kısmını oluşturur. Duygudurum dengeleyici ve antipsikotik ilaçların akut pankreatite neden olduğu bildirilmiştir. Bu yazıda kliniğimizde takip edilen mani döneminde bir hastanın valproat, olanzapin ve risperidon kullanımı ile ilişkili akut pankreatit vakası sunulmuştur. 63 yaşında kadın hasta kliniğimize, ilaçlarını almayı bıraktıktan sonra başlayan mani belirtileri ile başvurdu. Tedavisi için hastane servisine kabul edildi. Hasta tedavinin 5. gününde AP geliştirdi. Valproat 1000 mg/gün, olanzapin 10 mg/gün ve risperidon 4 mg/gün kullanıyordu. Amilaz (563 U/L) ve lipaz (3764 U/L) değerleri arttı. Mevcut ilaç tedavisinin kesilmesinden sonra, pankreatit semptomları azaldı. Manik semptomlar için 2 mg/gün lorazepam ve 600 mg/gün amisülpirid uygulandı. 3 haftalık tedaviden sonra manik semptomlar belirgin şekilde iyileşmişti. Taburcu olduktan sonraki üçüncü haftada ne pankreatit kliniği ne de manik semptomları yoktu. Ciddi bir mortalite ve morbidite nedeni olan AP, duygudurum dengeleyici ve antipsikotik ilaçlardan kaynaklanabilir. Tedaviye başlandıktan sonraki ilk 4-6 hafta boyunca, hastalar AP gelişimi riski açısından yakından izlenmelidir. AP için bir risk faktörü olarak kabul edilen çoklu ilaç kullanımından kaçınılmalıdır.

Anahtar Kelimeler:

bipolar bozukluk, pankreatit, olanzapin, valpoik asit, mani

A Case of Acute Pancreatitis Caused by Combined Use of Valproic Acid, Olanzapine and Risperidone

Acute pancreatitis (AP) is a reversible inflammatory process in which pancreatic tissue is affected. The development of drug-induced acute pancreatitis constitutes a small proportion of all acute pancreatitis. It has been reported that mood stabilizer and antipsychotic drugs cause acute pancreatitis. We are here presenting a case of acute pancreatitis associated with the use of valproate, olanzapine and risperidone by a patient in the mania period followed in our clinic. A 63-year-old woman patient presented to our clinic with symptoms of mania that began after she stopped taking her medication. She was admitted to the hospital ward for her treatment. The patient developed AP on the 5th day of treatment. She was using valproate 1000 mg/day, olanzapine 10 mg/day and risperidone 4 mg/day. Amylase (563 U/L) and lipase (3764 U/l) values increased. After discontinuation of the current drug therapy, the symptoms of pancreatitis reduced. Alprazolam 2 mg/day and amisulpride 600 mg/day were administered for manic symptoms. After 3 weeks of treatment, manic symptoms had significantly improved. At the third week after discharge, she had neither pancreatitis clinic nor manic symptoms. AP which is a serious cause of mortality and morbidity may be caused by mood stabilizing and antipsychotic drugs. In the first 4-6 weeks period following treatment initiation, patients should be closely monitored for the risk of AP development. Multidrug use, which is considered as a risk factor for AP, should be avoided.

Keywords:

bipolar disorder, pancreaititis, olanzapine, valproic acid, mania,

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