Elevated Serum Lipase/Amylase (lab finding)
Users on Reddit have shared varied experiences regarding elevated serum lipase and/amylase while on GLP-1 medications, with some reporting transient elevations without symptoms and others experiencing pancreatitis. Discussions also touch upon how healthcare providers interpret these findings.
Experiences with Elevated Serum Lipase/Amylase:
Some users have experienced pancreatitis, which is often associated with elevated lipase/amylase. One user mentioned, "I had a patient who’s A1C was 13+ and her pcp put her on full dose Metformin and a GLP1. 1 week later she gets admitted to ICU for DKA, so hypovolemic from GI side effects she needed a pressor, and pancreatitis presumably from GLP1. "[6]
Another user reported, "Pancreatitis requiring ICU. Recovered fine, this was trulicity. "[10]
An intensivist shared a severe case: "have seen necrotizing pancreatitis that went the whole nine yards - prolonged ICU course, compartment syndrome, open abdomen, CRRT, trach, PEG, multiple necrosectomies, TPN dependence. Pt was an otherwise healthy 40 year old. "[3] Another user also reported seeing this in a "completely healthy (except for mild obesity) person. "[4]
A surgeon mentioned seeing "a few cases of terrible necrotizing pancreatitis associated with the patient having started high dose GLP1a's. "[5]
One user recounted a coworker's experience: "coworker who developed pancreatitis and required hospitalization and had to argue with surgeon that she did not have acalculous cholecystitis and was forced to leave ama - she is fine now after stopping the GLP-1". [8]
Another user mentioned a "patient with pancreatitis, DKA after about 3 weeks on meds, admitted for a second time after re-starting his GLP-1". [8]
A user shared a story about a patient who developed pancreatitis after increasing their Ozempic dose themselves: "Interestingly he was fine on 1 mg weekly, increased himself to 2 mg, felt pancreatitis abdominal pain, and is now back to 1 mg weekly and doing fine. "[11]
One user mentioned a medical article about "acute necrotizing pancreatitis leading to death in a patient switching from Liraglutide to Tirzepatide I believe. They didn’t titrate. "[2]
Physician Approaches and Patient Concerns:
Some physicians prescreen for a history of pancreatitis and gallbladder issues and will not prescribe GLP-1s if there is such a history. [9, 12]
The official Wegovy information includes a warning: "Acute Pancreatitis: Has occurred in clinical trials. Discontinue promptly if pancreatitis is suspected. Do not restart if pancreatitis is confirmed (5. 2). "[7]
Remedies and Preventions (Implied or Discussed):
Dose Titration: Proper dose titration, especially when switching between GLP-1 medications, is crucial. One user mentioned a fatal case where a patient did not titrate when switching drugs. [2] Another user highlighted the importance of not self-increasing doses, as a patient experienced pancreatitis pain after doing so. [11]
Discontinuation: If pancreatitis is confirmed, the medication should be discontinued and not restarted. [1, 7]
Risk Assessment: Physicians may avoid prescribing GLP-1s to patients with a history of pancreatitis, especially if the cause was unknown. [12, 13] One user mentioned their doctor counsels patients on the risks and documents this. [11]
Avoiding Alcohol: One user mentioned a prescribing physician's advice to "avoid alcohol entirely" as patients of his who ended up in the ER did so due to pancreatitis linked to alcohol consumption. [14]
It's important to note that some discussions suggest that the risk of pancreatitis might be linked to the compounded versions of GLP-1s, though this is not definitively stated as a widespread consensus. [15] Additionally, some studies are emerging that suggest GLP-1s might even reduce pancreatitis risk in certain populations, which is contrary to earlier concerns.
Experiences with Elevated Serum Lipase/Amylase:
- One user, who is also a healthcare provider and a participant in a clinical trial for a GLP-1 medication, reported their "lipase was mildly elevated for 2 months but I had no symptoms, so they just rechecked my level and it came back down and I have continued on in the trial without any issues.
Physician Approaches and Patient Concerns:
- There's a concern that some providers might overreact to elevated enzymes.
Remedies and Preventions (Implied or Discussed):
- Monitoring and Symptom Awareness: The primary approach seems to be monitoring lipase levels and being aware of pancreatitis symptoms.
It's important to note that some discussions suggest that the risk of pancreatitis might be linked to the compounded versions of GLP-1s, though this is not definitively stated as a widespread consensus. [15] Additionally, some studies are emerging that suggest GLP-1s might even reduce pancreatitis risk in certain populations, which is contrary to earlier concerns.