Re: Pancreatitis from meds


"plutu" <plutu@xxxxxxxxxxxxxxx> wrote in message
news:45eeb276$0$17443$892e0abb@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Good day,
my granny (98 yo) suffers from pancreatitis episodes, she already went to
hospital 3 times and she always risked to die.

The pancreatitises are supposed to be from gallstones origin, however
these are inoperable because of her age etc. But she always had them,
while the pancreatitis episodes are relatively recent.

I noticed that two meds she has taken recently (and continues to take) can
cause sporadic pancreatitis episodes under cronic assumption: enalapril
maleate and furosemide. There is quite a lot of literature on Pubmed on
this, and for both meds. I understand that the gallstones probably do a
good part of the job, but inflamations IMHO are additive.

I noticed that among ace-inhibitors almost all are reported to have caused
some episodes of pancreatitis in literature except Fosinopril (and
Imidapril but that is not sold in my country).

What do you think about an enalapril to fosinopril replacement? I am not a
doctor.

If you think it's reasonable I would like to try to convince our doctor to
prescribe fosinopril (that won't be easy knowing our doctor so at least I
would like to know your opinion before).

The other one is furosemide. This I believe is even more difficult to
replace: almost all the other diuretics are reported to cause sporadic
pancreatitis episodes. The only class which does not have this problem I
think is anti-aldosterone. I know nothing of anti-aldosterones... can they
replace furosemide in an old woman with some hearth problems (chronic
atrial fibrillation, some degree of cardiac insufficiency).


Gallstone pancreatitis and chemical pancreatitis from those meds are two
completely different mechanisms and her doctor should have no difficulty in
determining which of the two mechanisms is the cause of her recurrent
pancreatitis. I think one can be fairly certain that the basis is gallstones
and that her meds are not contributing in any way.

Obviously, she needs to have her gallbladder removed. The risk of her dying
from that operation may very well be less than the risk of three or more
episodes of pancreatitis. Her doctors have likely put her at far greater
risk by NOT taking her gallbladder out.

HMc



.

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