Cannabinoid-Related Acute Pancreatitis: An Update from International Literature and Individual Case Safety Reports

Camille Azam, Louis Buscail, Adrian Culetto and Maryse Lapeyre-Mestre ()
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Camille Azam: Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, CIC 1436, CHU, Université de Toulouse
Louis Buscail: Service de Gastroentérologie et Pancréatologie, CIC Biotherapies 1436, CHU, Université de Toulouse
Adrian Culetto: Service de Gastroentérologie et Pancréatologie, CHU, Université de Toulouse
Maryse Lapeyre-Mestre: Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, CIC 1436, CHU, Université de Toulouse

Drug Safety, 2022, vol. 45, issue 3, No 2, 215-235

Abstract: Abstract Introduction In addition to the growing interest of different cannabinoids for therapeutic purposes, the safety profile of these substances has changed, with the recent identification of new events such as acute pancreatitis. Objective The aim of this study was to characterize cannabinoid-related acute pancreatitis, based on the recent literature and the analysis of pharmacovigilance data available worldwide. Methods Nine national and international pharmacovigilance databases were requested for individual case safety reports of acute pancreatitis related to cannabinoid exposure. A systematic review was performed searching in PubMed®, Web of Science®, and Google Scholar® for any publication dealing with acute pancreatitis and cannabinoid exposure (cannabis, cannabinoid, cannabidiol, tetrahydrocannabinol, nabilone, dronabinol), to identify case reports, observational studies, clinical trials, or reviews. All queries were updated on 1 January, 2021. Results Twenty-two individual case safety reports were identified in the pharmacovigilance databases and 51 in the literature, corresponding to a predominantly young male population (74% of men, median age 28 interquartile range [21–39]) using recreational Cannabis sativa with high intensity. A therapeutic purpose was identified in 13 cases (including tetrahydrocannabinol, cannabidiol, and dronabinol). The outcome was often favorable after dechallenge (except three deaths), and frequent recurrences were observed in the case of rechallenge or sustained consumption. Eleven cross-sectional studies and one ecological study showed an increasing trend of cannabis use in in-patients with acute pancreatitis, with a significantly lower in-hospital mortality. Conclusions This review underlines that acute pancreatitis is a potential adverse effect of cannabinoid use. It remains often unrecognized and can occur during recreational or therapeutic use. The development of the therapeutic use of cannabinoids in frail patients deserves a better investigation of the benefit-risk ratio of these different products.

Date: 2022
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DOI: 10.1007/s40264-022-01146-7

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