Pancreatitis occur with (DNB Dec 2010)
a. Didanosine is a reverse transcriptase inhibitor and is used as a part of highly active antiretroviral therapy.
b. It was the 2nd drug to be approved for treatment of HIV after zidovudine. Most common side effect is peripheral neuropathy. Though rare, pancreatitis is a major side effect and has been reported to cause fatality.
c. Therefore, the drug has a black box warning status. Incidence of pancreatitis with drug is 5-10% and risk of fatality is <0.4%. this drug should not be given with other drugs that can cause pancreatitis e.g. cotrimoxazole, pentamidine, corticosteroids, furosemide, OCPs etC.
d. Alcoholism increases its chances of causing pancreatitis. The drug also causes peripheral neuritis.
e. Lamivudine is a cytidine analogue and is a reverse transcriptase inhibitor. The drug has been used for hepatitis B. it is active both on hepatitis A & B.
f. The drug was approved in 1995 to be used in combination with zidovudine as a once a day drug. Lamivudine is given orally and has high first pass metabolism. The drug does not cause peripheral neuropathy.
g. Abacavir is a guanosine analogue and is a reverse transcriptase inhibitor. The drug has excellent oral bioavailability.
h. Major problem with this drug is high risk of hypersensitivity reaction which seems to have HLA susceptibility. Therefore, a preperception screening of HLA has been proposeD.
i. The drug can also aggravate liver disease. Abacavir has recently been associated with heart disease (CMDT’2010, pp-1228).
(Mnemonics: Didanosine sounds like daru( alcohol). Most common cause of pancreatitis is daru (alcohol)