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QUESTION: I need some help. I've experienced abdominal pain and hospitalized 2 times with pancreatitis. The doctors ran every test possible all negative. I've looked at possible side effects of montelukast and pancreatis is a rare one. Should I stop. I am in pain daily and doctors are stomped. I don't know why they didn't look into this. I have COPD and am on symbicort and spiriva. Help.

ANSWER: Hi Lynn,

 I looked into it, and yes, pancreatitis occurs rarely. There is another condition with rare reports: Churg-Strauss Syndrome, an eosinophylic vasculitis. Although it has not, from what I could find, been associated with the pancreas, it has been involved in multiple organ systems, including the liver. Another consideration with CSS is an association with asthmatic patients. Since COPD can also be of asthma origination, not just smoking, this is something to be ruled out. Also, when it occurs, is seems most commonly following steroid tapering, or a short oral steroid burst. But even this is not all cases.
 I would discontinue the montelukast, and investigate this possibility. Note though, while the montelukast may have been the trigger, its discontinuation will not reverse the syndrome, which itself must be treated.

Please keep me posted on the outcomes.



---------- FOLLOW-UP ----------

QUESTION: That information was very helpful. I forgot to mention that due to a genetic condition called divisum of the pancreas is that also a possibility of all these problems I'm having? Or since this condition did this medication trigger pancreatitis

ANSWER: Hi Lynn,

   I think I've found your answer at the National Pancreas Foundation! The following is taken directly from their site

  It is directly due to your genetic anomaly, which is the most common of the birth defects which occurs in the pancreas. When the embryo is developing, there are two lobes of the pancreas, with two separate ducts to drain each of the lobes. Before birth, both ducts fuse together into a larger, single duct. In the majority of cases, there are no problems in life, and remain undiagnosed. A small number of patients (lucky you!) will experience repeated episodes of pancreatitis due to a duct becoming blocked, swelling and tissue damage may develop.
  Diagnosis is made by:

    -Abdominal Ultrasound
    -Abdominal CT scan
    -Amylase and lipase blood tests
    -Endoscopic retrograde Cholangiopancreatography(ERCP)
    -Magnetic Cholangiopancreatography(MRCP)
    -Endoscopic Ultrasound

  Treatment, if the symptoms of the condition, or pancreatitis keeps returning:

    - ERCP with a cut to enlarge the opening where the pancreatic duct drains
    - placement off a stent to prevent the duct from becoming blocked.
    - surgery required if these approaches fail,

  Outcomes are generally good.

So, I think the montelukast probably had nothing to do with it, it probably was an unwanted, genetic gift from your folks (just like my receding hairline!)

 Hope this helps resolve your issue.

 Let me know how this all turns out!

 Best wishes!!



---------- FOLLOW-UP ----------

I hope you had a great holiday. I have been off montelukast and after a couple of weeks I have been pain free. I think it's a very strong possibility this has been causing all my issues.

A way of verification with medicine is to do a rechallenge to see if the issue immediately reoccurs, and is not coincidental to the initial discontinuation. That would be up to you. The alternative is, if it never again recurs once you've stopped it, highly likely it was the issue. But, of course, if you have another episode once you've continued to be montelukast free, then it was just coincidence, and you have to look at surgical repair.
  Wishing you a happy and MUCH healthier NewYear!




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Marc Rubin, RPh Asthma Educator


I have worked directly with patients as well as caregivers for over 30 years. Have made presentations throughout Illinois educating school nurses as well as the teaching and coaching staff of public schools about asthma, and how they should respond to these students needs. Presented a public education program on asthma through the US Department of Public Health. Specialize in helping guide asthmatic patients to take control of their disease in order to live a near-normal, fully active life.


Practicing pharmacist for 40 years, specializing in asthma and COPD for 12 years. Developed nationwide education to nurses, teachers and athletic coaches regarding asthma and exercise induced bronchospasm. In addition, and closer to home. my daughter has asthma, and my son has exercise induced bronchospasm. In addition, I serve on the boards and committees of a number of asthma organizations: Sports, Exercise and Fitness Committee of AAAAI, Population Health Committee and Sports Medicine Committee of ACAAI, Sports Medicine Committee of the World Allergy Association. Board of Directors of the Chicago Asthma Consortium, Board of Directors of the Christopher D. Redding Youth Asthma Foundation, as well as the advisory board of a medical education company, Emmi Solutions. Directly involved in the creation of public education programs for asthma, COPD and diabetes.

American Academy of Allergy, Asthma and Immunology / Sports Medicine Committee, American College of Allergy, Asthma and Immunology / Population Health Committee and Sports Medicine, American College of Chest Physicians, American Thoracic Society. World Allergy Association, Chicago Asthma Consortium / Professional Development Committee, Christopher D. Redding Youth Asthma Foundation, and Respiratory Health Association of Metropolitan Chicago: Development Committee for AE-C prep class, and presenter.

AAAAI PowerPoint on the new guidelines for EIB (Exercise Induced Bronchospasm), AAAAI Powerpoint on Asthma in School Setting for Teachers and Coaches, Annals of Allergy, Asthma and Immunology: Transition guide for teens with food allergies or asthma going out of the home to live independantly.

BScPharm, RPh, (NAECB Certified asthma educator in 2002), NIPCO Certified Respiratory Care Pharmacist

Past/Present Clients
Emmi Solutions, Chicago Next Level Health, Chicago

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