Pancreatitis due to codeine.
Pancreatitis is a rare adverse effect of codeine. We report the case of a 42-year-old man who suffered from epigastric pain 1 hour after taking a tablet containing amoxicillin plus clavulanic acid (500/125 mg) and another tablet containing acetaminophen plus codeine (500/30 mg) for a respiratory infection. He was admitted to the emergency room and was treated with metamizol and pantoprazole. A few minutes after receiving intravenous doses of both drugs he developed a maculopapular and itching eruption with facial angioedema. Laboratory tests showed high levels of serum amylase, GOT, GPT and total bilirubin. Serological tests for several viruses showed no evidence of recent infection. Ultrasonography was negative for biliary lithiasis and showed only cholecystectomy performed in 2000. The patient was sent to our department where skin prick and oral challenge tests were performed with negative results. For ethical reasons, oral challenge with codeine was not carried out. We believe that our patient had codeine-induced pancreatitis. The most likely underlying pathophysiological mechanism was probably codeine-induced spasm of the sphincter of Oddi combined with sphincter of Oddi dysfunction related to a previous cholecystectomy. Allergy departments should be aware of possible non-immunological adverse.
Moreno Escobosa
M C
MC
Sección de Alergia, Hospital Torrecárdenas, Almería, Spain. moreno.escobosa@terra.es
Amat López
J
J
Cruz Granados
S
S
Moya Quesada
M C
MC
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000082:Acetaminophen / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage / Q000627:therapeutic use; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use; D003061:Codeine / Q000008:administration & dosage / Q000009:adverse effects*; D004177:Dipyrone / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009853:Omeprazole / Q000031:analogs & derivatives / Q000627:therapeutic use; D010195:Pancreatitis / Q000139:chemically induced*; D000077402:Pantoprazole; D012141:Respiratory Tract Infections / Q000188:drug therapy; D013035:Spasm / Q000139:chemically induced; D009803:Sphincter of Oddi / Q000187:drug effects; D013454:Sulfoxides / Q000627:therapeutic use; D014839:Vomiting / Q000209:etiology
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D001562:Benzimidazoles; D013454:Sulfoxides; D000082:Acetaminophen; D004177:Dipyrone; D019980:Amoxicillin-Potassium Clavulanate Combination; D000077402:Pantoprazole; D009853:Omeprazole; D003061:Codeine