Psychotropic drugs and risk of pancreatitis: a systematic review and meta-analysis

Introduction: Psychotropic-associated pancreatitis is one of the most life-threatening adverse events. Well-controlled epidemiological studies are scarce and inconsistent. The objective of this systematic review and meta-analysis was to examine the associations between distinct classes of psychotropic medications and acute pancreatitis. Methods: International (PubMed, Web of Science, EMBASE, Cochrane Library, PsycINFO) and Chinese (China National Knowledge Internet, WANFANG Data and Chinese Biological Medical Literature) databases were systematically and independently searched by two researchers from the inception dates to October 9, 2024. The random and fixed-effects model were used to perform meta-analysis based on study heterogeneity. Data analyses were performed with STATA Version 18.0. Data analyses were performed with STATA Version 18.0. The study protocol was prospectively registered on PROSPERO (CRD420251017765) before the start of the study. Results: A total of 4109 publications were initially identified; of which, 7 studies had been included. First-generation antipsychotics were associated with an increased risk of AP only in past users (adjusted OR=1.36, 95% CI: 1.01-1.84). A significant association was observed between selective serotonin reuptake inhibitor (SSRI) use and acute pancreatitis risk (adjusted OR=1.18, 95% CI: 1.10-1.26), with non-SSRI antidepressants demonstrating a significantly association (adjusted OR=1.27, 95% CI: 1.14-1.41). Valproic acid presented heightened acute pancreatitis risk (crude OR=2.27, 95% CI: 1.57-3.27), with other antiepileptics also showing significant correlation (crude OR=1.87, 95% CI: 1.22-2.86). Benzodiazepine use was linked to 1.56-fold increased acute pancreatitis risk (adjusted OR=1.56, 95%CI: 1.43-1.69) and zopiclone/zolpidem indicated a significantly higher 3.22-fold risk increase (crude OR=3.22, 95% CI: 1.39-7.45). Conclusion: Psychotropic use is associated with an increased risk of acute pancreatitis. Patients taking psychotropic medications should be monitored regularly for pancreatic enzymes and clinical symptoms for early detection.