Abstract
Acute pancreatitis is a rare, adverse drug reaction. One of the most incriminated
drugs is valproic acid. We report the first case of acute pancreatitis induced by
valpromide (dipropylacetamide), a prodrug of valproic acid. A 75-year-old man developed
progressive encephalopathy, nausea, and abdominal tenderness 3 weeks after valpromide
(1800 mg/day) was initiated. Serum amylase and lipase levels fell to within the normal
range. Urine amylases were increased (354 U/l; normal <160 U/l). Abdominal computed
tomography scan showed signs of acute pancreatitis. After excluding other recognized
causes of pancreatitis, valpromide-induced pancreatitis was diagnosed. Valpromide
was immediately replaced by carbamazepin, and symptoms gradually improved. The likelihood
of valpromide being involved in the pathogenesis of the acute pancreatitis is plausible
according to Kramer's algorithm. The possibility of pancreatitis should be considered
immediately in cases of lethargy, abdominal pain, nausea or vomiting in patients taking
valproic acid or valpromide, and serum and urine amylases and lipase measurements
should be taken. Awareness is a key issue in the prevention of this serious complication,
and valproic acid or valpromide should be promptly discontinued.
Keywords
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Article info
Publication history
Accepted:
April 9,
1999
Received in revised form:
April 6,
1999
Received:
March 23,
1999
Identification
Copyright
© 1999 Elsevier Science B.V. Published by Elsevier Inc. All rights reserved.
