Pancreatitis / Necrotizing Pancreatitis
Users on Reddit, particularly in medical professional communities, report instances of pancreatitis and necrotizing pancreatitis in patients using GLP-1 medications. There's also discussion about whether a history of pancreatitis should be an absolute contraindication for these drugs, with some providers proceeding with caution and others avoiding it.
Experiences with Pancreatitis / Necrotizing Pancreatitis:
Severe cases, including necrotizing pancreatitis, have been noted. A user shared an experience of "Infected necrotizing pancreatitis requiring a complicated surgical and ICU course". [3] Another intensivist described seeing "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. "[11] This was echoed by another user who said, "I have also seen this…in a completely healthy (except for mild obesity) person". [12]
A GI nurse commented, "We’re seeing a lotttt of pancreatitis. Then it’s necrotizing and a huge walled off pseudo cyst. "[18]
A surgeon was reported to have "seen a few cases of terrible necrotizing pancreatitis associated with the patient having started high dose GLP1a's. "[9]
There are reports of pancreatitis leading to death. One user stated, "GLP1 -> pancreatitis -> death (less than 2 weeks)". [8] Another mentioned, "Death. Pancreatitis and they died about 3 days after their first dose. "[14] However, the credibility of this specific comment was questioned by another user. [15]
One user reported a case of "Pancreatitis after combining with mysimba". [16]
An emergency doctor shared an anecdotal observation: "coworker who developed pancreatitis and required hospitalization... patient with pancreatitis, DKA after about 3 weeks on meds, admitted for a second time after re-starting his GLP-1". [17]
A user mentioned, "I've pretty much seen the gamut: ... at least two episodes of pancreatitis one with necrosis". [19]
A patient with a history of alcohol-induced recurrent pancreatitis reportedly "felt pancreatitis abdominal pain" after increasing their GLP-1 dose themselves, and the pain resolved when they returned to the lower dose. [6]
One user shared a personal anecdote: "Just as a personal anecdote I had necrotizing pancreatitis and a distal pancreatectomy... We cautiously started a GLP-1 on me this year... I have had no real side effects from my GLP-1". [4]
Another user with a history of gallstone pancreatitis stated, "I had gallstone pancreatitis in the past and have not had issues with recurrence on GLP-1s for DM-2 personally. "[7]
Discussion on Prescribing with History of Pancreatitis:
Others weigh the cause of previous pancreatitis: "Depends on the cause. If it was alcohol or elevated lipids, sure. If unknown, no. "[23]
Some prescribers proceed with caution and informed consent: "Yes, they didn’t tolerate any other diabetic agent. Been on for 1 year and a1c is controlled and has done well. I just made sure to tell her it can happen and she accepts the risk and documented it in my note. "[5] Another said, "I discuss risks/benefits and document them firmly in the chart, but I have started them on a couple patients w/ hx of pancreatitis, without any issues thus far. "[20]
One user mentioned a patient with a history of alcohol-related pancreatitis who was hospitalized with pancreatitis again after starting a GLP-1, though it was suspected the patient resumed alcohol consumption. [22]
Remedies and Preventions Recommended:
Monitoring and Discontinuation: The Wegovy (semaglutide) prescribing 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). "[26]
Provider Discretion and Risk Assessment: Some providers will not prescribe GLP-1s if there's a history of pancreatitis. [21] Others consider the cause of the prior pancreatitis before prescribing. [23] One user stated, "Do you want to risk it? Because if you start them on a GLP-1 and they develop a pancreatitis flare, they will blame it on the GLP-1 and by extension, you when the malpractice lawyer comes knocking. "[27]
Elevated Lipase/Liver Enzymes: One user, a clinician in a trial, noted that elevated lipase or liver enzymes don't automatically mean pancreatitis and that medication shouldn't be stopped unless the patient is symptomatic or the elevation is significantly high (e. g. , three times the upper limit of normal). [1]
It's also mentioned that some believe compounded versions of GLP-1s might be more associated with pancreatitis than manufactured versions, though this is an individual's understanding.
Experiences with Pancreatitis / Necrotizing Pancreatitis:
- Some medical professionals have observed cases of pancreatitis.
Discussion on Prescribing with History of Pancreatitis:
- Some providers are hesitant: "I can only tell you that the Internal Medicine specialist I see for obesity management prescreens for a history of gallbladder and pancreatitis and will not prescribe GLP-1 if there is a history.
Remedies and Preventions Recommended:
- Cautious Dosing and Titration: One user mentioned a medical article about "acute necrotizing pancreatitis leading to death in a patient switching from Liraglutide to Tirzepatide I believe.
It's also mentioned that some believe compounded versions of GLP-1s might be more associated with pancreatitis than manufactured versions, though this is an individual's understanding.