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Medical Conditions & Resources

Disorders Of The Pancreas

Acute Pancreatitis

Chronic Pancreatitis

Hereditary Pancreatitis

Pancreatic Cancer

Medications for Disorders
of the Pancreas

The pancreas is an organ behind the stomach that has two important functions in the body. It makes and releases enzymes that help break down food during digestion. Lipase breaks down fats, amylase breaks down carbohydrates/sugars, and protease breaks down proteins. It also releases hormones that help to control blood sugar (glucose) levels. Insulin decreases high blood sugar levels, while glucagon increases low blood sugar levels. Disorders of the pancreas can create major problems with digestion and blood sugar control and need treatment to avoid many related health complications.

Disorders of the pancreas include pancreatitis, pancreatic cancer or neuroendocrine tumours, cysts, exocrine pancreatic insufficiency, and diabetes. Certain health conditions such as Cystic Fibrosis can significantly increase the risk of problems with the pancreas. Tumours and cysts will often require surgical removal or drainage. While changes in diet and lifestyle (healthy foods, avoiding smoking and alcohol, exercise) can help improve symptoms associated with pancreatic disorders, some form of medication treatment is usually needed.

Medications for Pancreatitis

Pancreatitis is a painful inflammation in the pancreas. Symptoms include tenderness and pain in the upper abdomen radiating to the back, fever, rapid heart rate, nausea and vomiting, oily diarrhoea, weight loss with no known cause, and abdominal pain that worsens after eating.  It can be acute, meaning it comes on suddenly and lasts for a few days, or chronic, lasting for months or even years. Acute pancreatitis may be due to gallstones, high triglyceride or calcium levels in the blood, high alcohol consumption, certain medications, infection, or injury to the abdomen. Chronic pancreatitis may be hereditary (genetic, passed from a family member) or autoimmune (a condition where the immune system attacks the body). Medications used for pancreatitis treat the symptoms and underlying causes.

  • Pain Medications (aka “analgesics”) are an important part of pancreatitis treatment because the condition can be very painful. Pain medications generally work by blocking pain signals to the brain, or by decreasing inflammation in nerve endings that cause pain. Mild pain may be treated with acetaminophen or NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen, naproxen, meloxicam, or diclofenac. Stronger pain medications for moderate to severe pain include the injectable NSAID, ketorolac, or opioid pain medications such as hydrocodone, oxycodone, meperidine, or hydromorphone. It is important to note that many prescription opioid pain medications may also contain acetaminophen, and additional over-the-counter pain medication could cause acetaminophen overdose.
  • IV (Intravenous) Fluids are usually given in cases of acute pancreatitis that require hospitalization. This can combat dehydration that occurs due to nausea, vomiting, abdominal pain, and decreased food intake. Common IV fluids are 0.9% sodium chloride solution (normal saline), dextrose 5% in water (D5W), and Lactated Ringers Solution (LR). Electrolytes such as potassium or magnesium may be added to correct low levels in the blood.
  • Nutritional Supplements may be given via a feeding tube in patients who cannot tolerate oral food or medications. It was once believed that patients with pancreatitis should be kept NPO, meaning “nothing by mouth” for several days to allow time for healing, but it is now thought that nutrition is needed to help speed healing and patients should eat a low-fat diet if possible.  Rarely, IV nutrition, or total parenteral nutrition (TPN), may be given when patients cannot eat and are not meeting nutritional needs with tube feeding. Supplements with vitamins may also be given because pancreatitis may decrease nutrient absorption. Antioxidants such as vitamin C, vitamin E, selenium, and methionine are thought to help aid in healing and reducing inflammation in pancreatitis.
  • Antibiotics are not routinely given in cases of pancreatitis, except in confirmed or suspected necrotizing pancreatitis, a rare, but serious complication involving infection of the pancreas. In these cases, IV meropenem, imipenem-cilastin, ciprofloxacin, levofloxacin, piperacillin-tazobactam, and/or metronidazole may be given.
  • Corticosteroids may be given to reduce inflammation in cases of autoimmune pancreatitis. Examples include prednisone, methylprednisolone, and dexamethasone.
  • Lipid Lowering Therapy will be given in cases of pancreatitis caused by high triglyceride levels. Medications used may include fenofibrate, gemfibrozil, niacin, fish oil, or statins (simvastatin, atorvastatin, rosuvastatin, etc.). However, in acute pancreatitis, triglyceride levels are often dangerously high and will need a different therapy to lower triglycerides quickly. Insulin, which will be discussed further in “Medications for Diabetes,” is usually used for this purpose.

Medications for Exocrine Pancreatic Insufficiency

Exocrine pancreatic insufficiency occurs when the pancreas does not produce enough digestive enzymes (amylase, lipase, protease), or the enzymes do not work well enough to adequately digest food. This can be caused by chronic pancreatitis, cystic fibrosis, diabetes, celiac disease, inflammatory bowel disease, weight loss surgery, or pancreatic cancer. This causes malnutrition and associated complications.

  • Pancreatic Enzyme Replacement Therapy (PERT) is oral medication given with meals to replace pancreatic enzymes and aid in digestion and nutrient absorption. Pancreatin, a combination of amylase, lipase, and protease, derived from pork pancreas hormones, is the active ingredient in several brands of pancreatic enzyme replacement medications. Different brands are not interchangeable and may require dosage adjustments from one product to another.

Medications for Diabetes

Diabetes is a chronic disease that results in uncontrolled blood sugar, usually hyperglycaemia, or high blood sugar/glucose, which can cause many serious complications throughout the body. Type 1 diabetes usually occurs during childhood and is characterized by the inability to make insulin. The symptoms (excessive thirst and urination, tiredness/weakness, blurred vision) are usually more severe and come on suddenly. In type 2 diabetes, which usually occurs in adulthood (though cases of type 2 diabetes in children are rising) the body is unable to use the insulin it produces effectively, and the symptoms usually have a slower onset. Gestational diabetes is diabetes that occurs during pregnancy and may go away after giving birth. Often, it is possible to prevent disease and help control blood sugar in type 2 diabetes with diet, exercise, and maintaining a healthy weight. However, many patients will need medication to help control blood sugar. Type I diabetics are considered “insulin dependent,” and will need medication treatment with insulin injections.

  • Insulin to replace the insulin normally made by the pancreas is the mainstay of treatment in type 1 diabetes and will sometimes be used in type 2 and gestational diabetes to help maintain healthy blood sugar levels. It is given via injections under the skin or with the use of an insulin pump. There are several types of insulin, classified by how quickly they begin working, and how long their effects last. Most patients will use a long-acting or intermediate-acting insulin once or twice a day, plus a short or rapid-acting insulin before meals. This is called “basal bolus” dosing. Insulin pumps are used to deliver a steady insulin dose throughout the day, plus additional insulin in response to eating. Some type 2 diabetics will only need once-daily injections of long-acting insulin. Rapid or short-acting insulins include regular insulin (ex- Humulin R), insulin glulisine, lispro, and aspart. Insulin NPH is an intermediate-acting insulin. Long-acting insulins include glargine, detemir, and degludec.

Oral Medications

  • Metformin is usually the first-line treatment for type 2 diabetes. It works by decreasing the amount of glucose made in the liver and increasing the insulin sensitivity of tissues in the body so that it can use insulin more effectively.
  • ­Sulfonylureas stimulate the pancreas to release more insulin. Examples include glyburide, glipizide, and glimepiride.
  • Meglitinides/Glinides also stimulate insulin release from the pancreas. They work more quickly than sulfonylureas. An example is repaglinide.
  • Thiazolidinediones decrease the amount of glucose made/released from the liver and increase insulin sensitivity. Examples are pioglitazone and rosiglitazone.
  • DPP-4 Inhibitors block an enzyme called dipeptidyl peptidase-4, decreasing glucose production in the liver and releasing insulin in response to rising blood sugar levels (i.e.-after a meal). Examples include sitagliptin, saxagliptin, and linagliptin.
  • SGLT2 Inhibitors block sodium-glucose transporters in the kidney, which absorb sugar back into the body, releasing extra glucose in the urine. Examples are dapagliflozin, empagliflozin, and canagliflozin.
  • GLP-1 Receptor Agonists are injectable medications that target the glucagon-like peptide-1 receptor, which slows digestion, increases insulin secretion in response to glucose to lowers blood sugar levels, and helps regulate appetite and food intake. Examples are exenatide, liraglutide, and semaglutide.

Medications for Pancreatic Cancer

Pancreatic cancer is an uncontrolled growth of cancer cells (tumour) starting in the pancreas and usually spreading to other parts of the body (metastasis). It can be very difficult to detect in its early stages due to the position of the pancreas in the abdomen and because early on, there aren’t usually any symptoms. Unfortunately, pancreatic cancer is usually in an advanced stage before it is diagnosed. Treatment usually consists of surgery to remove the tumour(s) or part or all of the pancreas, radiation therapy, and chemotherapy (medication that destroys cancer cells).  Chemotherapeutic drugs can be given orally or as injections or infusions, and some common medications that may be used to treat pancreatic cancer include gemticabine, capecitabine, paclitaxel, fluorouracil, irinotecan, and oxaliplatin. Usually, treatment consists of a combination of multiple chemotherapy drugs given on a particular schedule. Chemotherapy may cause many side effects, and medications to help manage these such as pain relievers, nausea medications, allergy medications, or corticosteroids are often given.

Side Effects

Side effects are possible with most medications. Some common ones you may experience while taking medications for disorders of the pancreas include:

  • Nausea/vomiting
  • Fatigue/tiredness
  • Urinary tract or yeast infection
  • Abdominal pain or bloating
  • Dizziness
  • Hypoglycaemia (low blood sugar)
  • Gas/flatulence
  • Headache
  • Weight gain or loss
  • Diarrhoea OR constipation
  • Increased or decreased appetite

Some serious, but rare side effects associated with these medications are discussed below:

  • Opioid addiction/dependence is possible when taking opioid pain medications. It is important that you take them exactly as prescribed and for a short period of time, if possible.
  • Clostridium difficile (C. diff) infection can occur when taking antibiotic medications because they kill the “good” bacteria in your gut and allow the overgrowth of “bad” bacteria. If you experience severe and/or bloody diarrhoea while taking antibiotics, seek medical attention right away.
  • Pancreatitis is a rare side effect of taking several types of medication, including the GLP-1 agonists for diabetes. If you experience severe abdominal pain while taking one of these medications, seek medical attention.
  • Blood Count Abnormalities are a possible side effect of many medications, particularly chemotherapy medications. If you notice easy, or unexplained bleeding or bruising, you should seek medical attention as soon as possible.
  • Organ Dysfunction can occur with many medications because the body metabolizes and eliminates them through the kidneys and liver, especially. It is important to notify your doctor immediately if you notice a decrease in urine output or yellowing of the skin or whites of your eyes. Regular follow-up with your healthcare provider and getting routine bloodwork can help detect organ function problems and blood count abnormalities.
  • Heart Problems are a rare, but very serious side effect of NSAIDs used for pain control and some diabetes and chemotherapy medications. If you have chest pain, irregular heartbeat, extreme weakness or tiredness, swelling in your legs/feet, and/or chest pain, you should seek medical help right away.
  • Lactic Acidosis is a very rare, but serious side effect of taking the diabetes medication, metformin. This usually occurs when organ dysfunction such as liver or kidney failure is present.

Conclusion

It is important to maintain a healthy lifestyle, including a healthy diet, regular exercise, or avoiding smoking and drinking large amounts of alcohol to help keep your pancreas healthy and decrease the risk of serious health problems associated with the pancreas. Fortunately, there are many treatment options available to help you manage many problems with the pancreas. It is important to follow up with your healthcare provider regularly and take your medications exactly as prescribed.

 
 
 

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