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Title: Case Report: Mirtazapine Associated With Hypertriglyceridaemia, Acute Pancreatitis And Diabetic Ketoacidosis

URL: http://www.accp.com/pharmacotherapy/pharm2307.php#13

Pharamcotherapy 2003;23:7:940-944. "Hypertriglyceridemia, acute pancreatitis, and diabetic ketoacidosis possibly associated with mirtazapine therapy: a case report"
08/13/2003 02:07:58 PM
By Keely S Solomon, PhD

Mirtazapine therapy may have caused hypertriglyceridaemia, acute pancreatitis and diabetic ketoacidosis in a 44-year old Caucasian woman, according to a recent case report from The University Hospital for the Albert Einstein College of Medicine, United States. Mirtazapine is an antidepressant with a tetracyclic structure. Both acute pancreatitis and new-onset diabetes have been reported as possible adverse effects in early clinical trials. However, only 3 sub-clinical cases of possible mirtazapine-induced pancreatitis have been published, all without concurrent diabetes complications. Julie L. Chen, Pharm.D., and colleagues have reported a case of a woman admitted with severe epigastric pain after taking mirtazapine (45 mg/day) for two months. She had a medical history of major depression and obsessive-compulsive disorder. The patient was obese (BMI, 43.7 kg/m[²), and laboratory tests revealed elevated serum triglycerides (2055 mg/dL), serum amylase (478 U/L) and lipase (1059 U/L) levels. White blood cell count, glucose, aspartate aminotransferase and alanine aminotransferase were also elevated, and an increased anion gap metabolic acidosis was detected. Urinalysis was positive for ketones and glucose. The patient was diagnosed with acute pancreatitis with concurrent diabetic ketoacidosis. A drug-induced therapy was suspected after other possible causes of acute pancreatitis, such as excessive alcohol consumption or gallstones, were ruled out. Mirtazapine was specifically suspected because it was the only drug recently started. Oral gemflibrozil (600 mg twice/day) was initiated, together with other supportive care, and all of the patient's previous drugs except mirtazapine were restarted. After 3 days, serum amylase and lipase levels returned to normal and the abdominal pain resolved. Serum triglycerides continued to improve during the 17-day hospitalisation, and the acute pancreatitis and diabetes were resolving at the time of discharge. Two months later, cholesterol and triglyceride levels were 194 and 101 mg/dL, respectively, serum amylase and lipase levels were within the normal range, and the diabetes was under good control. The researchers advise that, "health care providers should be aware of these possible serious complications associated with mirtazapine therapy." For patients receiving this treatment, they recommend, "serum glucose and lipid levels, and especially triglycerides, should be measured at baseline and monitored regularly thereafter."

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