title: Elevated amylase and lipase levels in patients using glucagonlike peptide-1 receptor agonists or dipeptidyl-peptidase-4 inhibitors in the outpatient setting.
abstract: OBJECTIVE
  To investigate the effects of glucagonlike peptidase-1 (GLP-1) receptor agonists and dipeptidyl-peptidase-4 (DPP-4) inhibitors on serum amylase and serum lipase levels in patients with type 2 diabetes.
  
  
  METHODS
  In 90 patients with type 2 diabetes, treatment was initiated with a GLP-1 agonist or a DPP-4 inhibitor. A comparison group consisted of 33 patients with type 2 diabetes and similar characteristics who were not prescribed these agents. Baseline serum amylase and lipase levels were measured in all patients and repeated periodically. We determined the percentage of patients with elevated levels of serum amylase or lipase (or both) in both groups.
  
  
  RESULTS
  Among all 90 patients who received a GLP-1 receptor agonist or a DPP-4 inhibitor, 32 (36%) had an increase in serum amylase or lipase (or both) in comparison with 6 of 33 patients (18%) with such increases in the comparison group. Interestingly, the serum lipase levels increased more than the serum amylase values in all groups. To ascertain that this was not a chance laboratory error, serum samples were submitted to a second independent laboratory, and the same results were obtained. Usually, use of the medication was discontinued when serum lipase or amylase values were found to be elevated at any level.
  
  
  CONCLUSIONS
  Both GLP-1 receptor agonists and DPP-4 inhibitors are associated with increased levels of serum lipase more than serum amylase in many patients with type 2 diabetes, possibly suggesting the presence of pancreatic inflammation. Whether this finding may potentially lead to acute pancreatitis or chronic pancreatitis, as reported in rat models, is currently unknown. Careful observation of patients taking these medications may be prudent.
authors.affiliation: Department of Medicine, George Washington University, Washington, District of Columbia, USA. hlando@yahoo.com
authors.forename: Howard M
authors.initials: HM
authors.lastname: Lando
authors.forename: May
authors.initials: M
authors.lastname: Alattar
authors.forename: Anuradha P
authors.initials: AP
authors.lastname: Dua
mesh_terms: D000218:Adamantane / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D004151:Dipeptides / Q000009:adverse effects / Q000627:therapeutic use; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D016903:Drug Monitoring; D000077270:Exenatide; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000819:agonists*; D000067757:Glucagon-Like Peptide-1 Receptor; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008049:Lipase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000187:drug effects* / Q000201:enzymology / Q000276:immunology; D055292:Pancreatic alpha-Amylases / Q000097:blood; D010195:Pancreatitis / Q000139:chemically induced* / Q000503:physiopathology; D010455:Peptides / Q000009:adverse effects / Q000627:therapeutic use; D011719:Pyrazines / Q000009:adverse effects / Q000627:therapeutic use; D018027:Receptors, Glucagon / Q000819:agonists*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D000068900:Sitagliptin Phosphate; D014230:Triazoles / Q000009:adverse effects / Q000627:therapeutic use; D014688:Venoms / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D004151:Dipeptides; D054873:Dipeptidyl-Peptidase IV Inhibitors; C000593833:GLP1R protein, human; C000593835:Glp1r protein, rat; D000067757:Glucagon-Like Peptide-1 Receptor; D007004:Hypoglycemic Agents; D010455:Peptides; D011719:Pyrazines; D018027:Receptors, Glucagon; D014230:Triazoles; D014688:Venoms; D052216:Glucagon-Like Peptide 1; C502994:saxagliptin; D000077270:Exenatide; D008049:Lipase; C518354:PNLIP protein, human; D055292:Pancreatic alpha-Amylases; D000218:Adamantane; D000068900:Sitagliptin Phosphate