What medications affect lipase levels?

Drug-induced pancreatitis

In rare cases, inflammation of the pancreas can be caused by medicinal products. With the following three case studies from the Swissmedic pharmacovigilance database, Swissmedic is giving a reminder not to forget medicinal products as a possible cause of acute pancreatitis in differential diagnosis.

Key words: pancreatitis; Ozempic; semaglutide; Imurek; azathioprine; isotretinoin

Medicinal product: Ozempic®

Active substance: Semaglutide

Indication: Type II diabetes

ADR: Acute pancreatitis

The patient was admitted to hospital as an emergency with upper abdominal pain radiating to the back. She had increased lipase levels, and acute pancreatitis was diagnosed on imaging.

The patient had been treated with semaglutide for one year, which was then discontinued on hospitalisation. Semaglutide was considered to be a possible cause of the acute pancreatitis. No further details are available on the outcome of the adverse drug reaction (ADR).

If acute pancreatitis is confirmed, treatment with Ozempic® should not be restarted. Patients with a history of pancreatitis were not treated with semaglutide in the clinical trials. Caution is therefore advised in these patients.

Medicinal product: Imurek®

Active substance: Azathioprine

Indication: Crohn’s disease

ADR: Acute pancreatitis

This patient with Class 2 obesity had recently been diagnosed with Crohn’s disease and began treatment with azathioprine 100 mg/day 20 days earlier.

He presented as an emergency with severe upper abdominal pain. Laboratory tests found increased amylase (470 U/L) and lipase (824 U/L). An abdominal X-ray showed no air under the diaphragm and a CT scan found no acute abdominal changes. The clinical picture of acute pancreatitis was attributed to the recently started azathioprine therapy, and the medication was discontinued.

The patient was treated with parenteral fluid administration and analgesics. Symptoms decreased with these measures and the increased pancreatic enzymes in the serum returned to normal levels.

Various symptoms are described in connection with medicinal products containing azathioprine, which evidently involve hypersensitivity reactions without prior sensitisation such as: feeling generally unwell, dizziness, nausea, vomiting, diarrhoea, fever, muscle and joint pains, skin rash, erythema nodosum, vasculitis, impaired renal function, hepatic disorders and cholestasis, cholestatic jaundice, pancreatitis, abnormal heart rhythms and hypotension.

A connection with azathioprine has been confirmed in many cases by re-challenge.

Active substance: Isotretinoin

ADR: Acute pancreatitis

After taking isotretinoin to treat acne, the patient experienced abdominal pain and involuntary vomiting. A blood test showed increased lipase levels, with no evidence of increased triglycerides. A CT scan of the abdomen indicated slightly oedematous acute pancreatitis. The symptoms improved after the medicinal product was discontinued.

Isotretinoin has been associated with an increase in plasma triglyceride levels. Treatment with isotretinoin must be discontinued when hypertriglyceridaemia cannot be controlled at an acceptable level or when symptoms of pancreatitis occur. Levels exceeding 800 mg/dl or 9 mmol/l are sometimes associated with acute pancreatitis, which can be fatal.

Summary and recommendation

Although medicinal products are rarely the trigger of pancreatitis, this possibility should always be considered in a differential diagnosis if other causes are excluded.

Healthcare professionals are requested to report serious and/or previously unknown adverse drug reactions to Swissmedic. Please use the Electronic Vigilance Reporting Portal “ElViS” for this purpose.

Supplementary information

Chronic Pancreatitis

Your pancreas is an organ with many important functions. It makes enzymes that help you digest food. It also makes insulin to keep your blood sugar levels under control.

Short-term (acute) pancreatitis is a sudden inflammation of your pancreas. This can be very painful. You may have nausea, vomiting, and fever. If your acute pancreatitis doesn’t get better and slowly gets worse, you may have chronic pancreatitis.

What causes chronic pancreatitis?

If you have chronic pancreatitis, the digestive enzymes that would normally travel by tubes inside your pancreas and empty into your upper intestine, become trapped inside your pancreas. This causes pain and scarring. The trapped enzymes slowly cause severe damage to your pancreas.

The most common cause of chronic pancreatitis is drinking a lot of alcohol over a long period of time.. Other causes include:

An attack of acute pancreatitis that damages your pancreatic ducts
A blockage of the main pancreatic duct caused by cancer
Certain autoimmune disorders
Cystic fibrosis
Hereditary diseases of the pancreas
Smoking
Unknown cause in some cases

What are the symptoms of chronic pancreatitis?

Early symptoms of chronic pancreatitis are similar to acute pancreatitis. Symptoms are occasional and include:

Pain in the upper belly that spreads into the back
Pain in the belly that gets worse when you eat or drink alcohol
Diarrhea or oily stools
Nausea and vomiting
Severe belly (abdominal) pain that may be constant or that comes back
Weight loss

Chronic pancreatitis causes severe damage to your pancreas. This means that your body won’t be able to make needed enzymes and hormones. This can result in malnutrition, because you won’t be able to digest foods. Chronic pancreatitis can also cause diabetes. This happens because your pancreas can’t make insulin. Insulin controls blood sugar.

How is chronic pancreatitis diagnosed?

Your healthcare provider will diagnose you with chronic pancreatitis if:

You have a history of acute pancreatitis that comes back or doesn’t get better
You have symptoms of chronic pancreatitis

Your healthcare provider will examine your belly. You will also be asked about your drinking history and any family history of pancreatic disease or cystic fibrosis. Blood and imaging tests are an important part of your diagnosis. They can include:

Blood tests. They will look for high levels of two pancreatic enzymes, amylase and lipase. These may spill into your blood. Other tests may show blockage or damage of your gallbladder. They can also be used to check for certain inherited conditions. You may need vitamin levels and other lab tests.
CT scan. This test creates a 3-D image of your pancreas, using X-rays and a computer.
Abdominal ultrasound. This test uses sound waves to create an image of your pancreas.
Endoscopic ultrasound. This test uses a long, thin tube (endoscope) that is put through your mouth and into your stomach and upper intestine. An ultrasound on the scope makes images of the pancreas and gallbladder ducts.
ERCP. This test uses a long, thin tube (endoscope) that is put into the pancreas drainage area if treatment needs to be done.
Magnetic resonance cholangiopancreatography. This test makes images using radio waves, a strong magnet, and a computer. In some MRI tests, you will need to have dye injected to show a more detailed image of your pancreas and the ducts of your gallbladder.

How is chronic pancreatitis treated?

Day-to-day treatment includes:

Pain medicine
Pancreatic enzyme supplements with every meal
Insulin, if you develop diabetes
Vitamin supplements, if needed

For acute pancreatitis or a flare-up, you may need to stay in the hospital for treatment. Your exact treatment will depend on the cause of your chronic pancreatitis, how severe the symptoms are, and your physical condition. Acute treatments may include:

Feeding through a tube through the nose into the stomach
Fasting
IV fluids
Pain medicines

What are possible complications of chronic pancreatitis?

Chronic pancreatitis damages the insulin-producing cells of the pancreas. This may cause these complications:

Calcification of the pancreas. This means the pancreatic tissue hardens from deposits of calcium salts.
Long-term (chronic) pain
Diabetes
Gallstones
Kidney failure
Buildup of fluid and tissue debris (pseudocysts)
Pancreatic cancer
Acute flare-ups that keep coming back

How can I help prevent chronic pancreatitis?

The best way to prevent chronic pancreatitis is to drink only in moderation or not at all. Moderate alcohol drinking is considered to be no more than 1 drink per day for women and 2 drinks per day for men. Quitting smoking is also very helpful. It eases pain and swelling.

Living with chronic pancreatitis

If you have been diagnosed with chronic pancreatitis, your healthcare provider may suggest these lifestyle changes:

Don’t drink alcoholic drinks.
Drink plenty of water.
Don’t smoke.
Steer clear of caffeine.
Stick to a healthy diet that’s low in fat and protein.
Eat smaller and more frequent meals.

When should I call my healthcare provider?

Call your healthcare provider when you start to have short-term (acute) symptoms, including:

Severe pain that can’t be eased at home
Vomiting and are unable to keep down fluids

Key points about chronic pancreatitis

Acute pancreatitis is a sudden inflammation of your pancreas. If your acute pancreatitis doesn’t get better and slowly gets worse, you have chronic pancreatitis.
If you have chronic pancreatitis, the digestive enzymes that would normally travel by tubes inside your pancreas and empty into your upper intestine, become trapped inside your pancreas.
Your healthcare provider will examine your belly. You will be asked about your drinking history and any family history of pancreatic disease or cystic fibrosis.
Day-to-day treatment includes pain medicine, pancreatic enzyme supplements with every meal, insulin if you develop diabetes, and vitamin supplements if needed.
If you have been diagnosed with chronic pancreatitis, your healthcare provider may suggest lifestyle changes.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your healthcare provider if you have questions.

Medical Reviewer: Jen Lehrer MD
Medical Reviewer: Rita Sather RN
Medical Reviewer: Raymond Kent Turley BSN MSN RN

Lipase Test

Lipase is an enzyme produced by the pancreas that helps the body digest fats. An elevated amount of lipase in the blood can signify that the pancreas is swollen and inflamed, a condition called pancreatitis. Lipase may also be elevated due to other issues in the pancreas, the use of certain medications, or health conditions such as kidney disease, cancer, and problems with the gallbladder or esophagus.

A lipase test measures the amount of lipase in the blood. Your doctor may order a lipase test if you are having abdominal pains or other symptoms that could be caused by pancreatitis. They may also order it to evaluate other health conditions you may have.

About the Test

Purpose of the test

The purpose of lipase testing is to assess for diseases of the pancreas, most commonly acute pancreatitis. An organ located behind the stomach, the pancreas produces important hormones as well as chemicals called enzymes. Acute pancreatitis is a health condition in which the pancreas becomes inflamed and swollen.

Lipase testing is sometimes used to diagnose chronic pancreatitis, a long-term condition that can cause permanent damage to the pancreas. The lipase test may also be ordered to diagnose other health conditions including:

Intestinal obstruction or injury
Pancreatic cysts
Peritonitis
Cystic fibrosis

What does the test measure?

A lipase test measures the amount of the pancreatic enzyme lipase found in the blood. Lipase is a digestive enzyme produced by the pancreas. These enzymes help break down foods during digestion so the body can absorb them. Lipase plays an important role in digesting fats, so it’s normal to have some lipase in the blood.

When the pancreas is damaged or inflamed, it produces larger amounts of lipase. If you have acute pancreatitis, blood levels of lipase are usually highest during the first day that symptoms develop. Levels of lipase usually return to normal within 14 days.

When should I get this test?

Your doctor may recommend a lipase test if you are experiencing symptoms that could be related to an abnormal pancreatic condition, especially suggestive of acute pancreatitis.

Symptoms of acute pancreatitis may include:

Pain in the abdomen
Abdominal swelling or tenderness
Fever
Vomiting and nausea
Rapid heartbeat
Pale stools
A full or bloated feeling
Jaundice, a yellowing of the skin and eyes

The lipase test may be given alone or in combination with imaging or other blood tests such as an amylase test.

Finding a Lipase Test

How can I get a lipase test?

Your doctor is usually the one to order a lipase test for you. This may be conducted in a hospital setting or in your doctor’s office. Your doctor may also refer you to an outside lab to conduct the test.

Can I take the test at home?

No at-home lipase test is currently available. The lipase test requires laboratory analysis of a blood sample drawn by a trained health care professional.

How much does the test cost?

The total cost of lipase testing may be made up of several components. These can include the price of your doctor’s appointment or hospital admission, fees for taking your blood sample, and fees for analyzing your sample.

If you have medical insurance coverage, your insurance provider will routinely cover many of these costs. You will likely still be responsible for certain out-of-pocket expenses such as copayments or deductibles.

To learn more about the expenses you could incur from this test, talk to your doctor or other members of your medical team. It may also be helpful to discuss expenses with your health insurance company and the billing department of the lab or hospital.

Taking a Lipase Test

The lipase test is most often performed on a blood sample drawn from a vein. A blood draw may be performed in a hospital, clinic, laboratory, or doctor’s office.

Before the test

The lipase test often requires fasting. This means that you should not eat or drink anything besides water for at least eight hours before your test.

Before you take a lipase test, tell your doctor about any prescription or

over-the-counter drugs you regularly take or have recently taken. Some drugs, such as birth control pills and opioids like codeine, can cause elevated levels of lipase and interfere with the interpretation of test results.

During the test

The blood sample used for lipase testing is frequently collected from a vein in your arm, often from the pit of your elbow.

The health professional who takes your blood sample will clean the skin around the vein with a sterile wipe and may apply a band called a tourniquet to your upper arm. Your blood is drawn through a small needle inserted through your skin and into your vein. The blood collects in a tube attached to the needle.

It’s normal to feel a small amount of stinging or pain when the phlebotomist inserts or withdraws the needle. The complete process of drawing blood rarely takes longer than a few minutes.

After the test

When the health professional finishes drawing blood, they will place a small bandage over the injection site. This can stay in place for several hours if needed. You may notice slight pain or a bruise where the needle went in, but these are typically minor and will go away quickly.

If you fasted before taking the test, you may wish to bring a snack with you in case you are hungry once the test is complete.

Lipase Test Results

Receiving test results

Your lipase test results are usually ready within a few hours to a couple of days, depending on where the test is performed and how urgent your condition may be.

If you are in the hospital, your doctor may be able to discuss the test results with you shortly after the lab completes its analysis. You may also be able to access your results through an online portal, or receive them by postal mail or email.

Your doctor may wish to discuss your test results in person at a follow-up appointment. You may also be able to discuss them over the phone or by email.

Interpreting test results

Lipase results are commonly reported as units per liter, or U/L. They may also be given as microkatals per liter, represented as microkat/L or µkat/L.

You will see a reference range included in your test results which indicates the expected values of lipase in the blood for healthy adults. The range given can depend on the method used to conduct the test and the laboratory performing the analysis.

Elevated lipase may be detected in a variety of health conditions. In acute pancreatitis, blood lipase may be greater than three times the upper limit of the reference range. The lipase test is better than the amylase test for the diagnosis of acute pancreatitis because it is relatively more specific and it remains elevated longer than amylase.

Many other conditions can cause lipase levels to be higher than normal, although lipase levels aren’t usually as high as in acute pancreatitis. These conditions include diseases of the kidneys, liver or gallbladder, obstructions of the intestines, cancer or perforation of the stomach, inflammatory bowel disease, diabetes, and infections.

It’s important that you discuss your lipase test results with your doctor to learn their meaning. Your doctor can explain your results in relation to your health history and other tests you may have had.

When you discuss the results of your lipase test with a doctor, asking these questions may be helpful:

What are my lipase test results?
Is my lipase level within the reference range?
What do my test results mean about my health?
Will I need additional follow-up tests?

Related Tests

Amylase
Chymotrypsin
Immunoreactive Trypsinogen (IRT)
Stool Elastase

Resources

National Association of Diabetes and Digestive and Kidney Diseases: PancreatitisLearn More
National Library of Medicine: PancreatitisLearn More