Doxycycline not to blame for acute pancreatitis

A recent study examined a probable case of oral doxycycline inducing pancreatitis in a patient initially treated for Lyme disease. However, there have been only two documented cases of doxycycline causing acute pancreatitis. The authors case report of acute pancreatitis was caused by diabetic ketoacidosis.

by Daniel J. Cameron, MD MPH

Study examines doxycycline as cause of acute pancreatitis in patient initially treated for suspected Lyme disease.

A 51-year-old man was admitted to the hospital with a one-week history of extreme fatigue, malaise, and confusion. Three days prior to admittance, the man had started oral doxycycline for presumed Lyme disease (LD). There were no reports of tick bites, high risk behaviors for contracting LD, or objective evidence of the disease. [1]

Upon further testing, the patient was diagnosed with acute pancreatitis. His labs revealed a lipase concentration of 5410 units/L (normal range, 13—60 units/L), an amylase concentration of 1304 (normal range, 28—100 units/L). A computed tomography (CT) scan of the abdomen showed mild stranding in the surrounding fat near the head of the pancreas, wall thickening of the duodenum, but no encapsulated fluid collection. [1]

The study published in the March 2016 issue of the American Journal of Health-System Pharmacy concluded that doxycycline was the probable cause of the man’s acute pancreatitis. Moy and colleagues, from the University of Connecticut Health Center, Department of Medicine came to this conclusion despite their admission that “Drug-induced pancreatitis is a diagnosis of exclusion; other etiologies of pancreatitis should be ruled out before concluding that drugs are the cause.”

The authors did not rule out other well-known etiologies of acute pancreatitis. The man presented with poorly controlled diabetes with a HA1C of 15 (normal, <5.7%), a blood sugar of 11,161 mg/dL (normal, 65—91 mg/dL), acidosis with a ph of 7.12, serum osmolality of 420 mOsm/kg (normal, 285—295 mOsm/kg), and renal failure with a creatinine concentration of 4.6 mg/dL (normal, 0.5—1.3 mg/dL).

The man rapidly improved with standard treatment for diabetic ketoacidosis. He was intubated, started on vasopressor support; received aggressive fluid resuscitation, hemodialysis and an insulin infusion.

Diabetes and DKA are also well-described causes of acute pancreatitis. Acute pancreatitis has been associated with Type 2 diabetes [2] and diabetic ketoacidosis. [3]

Doxycycline would be a reasonable treatment for a 51-year-old man who presented with a one-week history of extreme fatigue, malaise, and confusion. LD complications include Lyme encephalopathy, [4] chronic neurologic LD, [5] neuropsychiatric LD, [6] and post-treatment LD. [7]

The case report reminds us of the need to follow up with patients. The International Lyme and Associated Diseases Society‘s (ILADS) evidence-based guidelines discusses the need for reassessment. For example, Recommendation 3C states, “Clinicians should re-assess patients immediately following the completion of the initial course of retreatment to evaluate the effectiveness of retreatment and the need for therapeutic adjustments.” The guideline points out “Reassessment may need to be done much earlier and with greater scrutiny in patients with severe disease or when the therapeutic intervention carries substantial risk.”

There are side effects of doxycycline including photosensitivity and c. difficile. Typically, acute pancreatitis is not one of them. This patient’s illness was not caused by a 3-day course of doxycycline. In fact, the case study could only find two reports of doxycycline causing acute pancreatitis.



  1. Moy BT, Kapila N. Probable doxycycline-induced acute pancreatitis. Am J Health Syst Pharm, 73(5), 286-291 (2016).
  2. Gonzalez-Perez A, Schlienger RG, Rodriguez LA. Acute pancreatitis in association with type 2 diabetes and antidiabetic drugs: a population-based cohort study. Diabetes Care, 33(12), 2580-2585 (2010).
  3. Nair S, Yadav D, Pitchumoni CS. Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA. Am J Gastroenterol, 95(10), 2795-2800 (2000).
  4. Logigian EL, Kaplan RF, Steere AC. Successful treatment of Lyme encephalopathy with intravenous ceftriaxone. J Infect Dis, 180(2), 377-383 (1999).
  5. Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med, 323(21), 1438-1444 (1990).
  6. Fallon BA, Nields JA, Parsons B, Liebowitz MR, Klein DF. Psychiatric manifestations of Lyme borreliosis. J Clin Psychiatry, 54(7), 263-268 (1993).
  7. Aucott JN, Rebman AW, Crowder LA, Kortte KB. Post-treatment Lyme disease syndrome symptomatology and the impact on life functioning: is there something here? Qual Life Res, 22(1), 75-84 (2013).

17 Replies to "Doxycycline not to blame for acute pancreatitis"

  • Liana W
    09/27/2021 (7:01 am)

    I absolutely have a documented case of drug induced acute pancreatitis (without necrosis) caused by doxycycline, I’ve never been treated for lyme disease and would be happy to share my records with you for research.

    • Dr. Daniel Cameron
      09/27/2021 (2:52 pm)

      The blog refers to a published case of someone whose pancreatitis was more likely due to diabetic acidosis. The authors were only able to find two cases in the literature where pancreatitis was related to doxycycline. Thanks for sharing your case.

  • Kelly Miller
    08/12/2021 (8:04 am)

    Interestingly, so many people take this medication and then present with acute pain in the abdomen several days after. My daughter is as admitted last night, second time in a year now, for this exact event. Does she have pre-existing stomach problems? Yes. She has been unable to tolerate NSAIDS and has general gastritis, undetermined cause, flares up. Non-celiac. Has this pattern of feeling like she is going to die 3-5 days post doxycycline happened twice in one year. Yes. Exactly so. She does not have Lyme disease. She was tested twice for this over the last five years. She is now in the hospital.

    • Dr. Daniel Cameron
      08/12/2021 (8:11 am)

      I have patients who cannot tolerate doxycycline even when taking it with food, probiotics and medications to control acids. In some cases, I have had to prescribe an antibiotic not related to doxycycline.

  • Peter Kiryluk
    08/25/2019 (12:45 am)

    I’m a 34 year old male with lyme and Doxycycline if 100% responsible for my inflamed pancreatitis it really makes ur stomach hurt , when i paused taking it, all that stopped. Restarted and again the same thing happened. It is 100% a side effect. Other then that im healthy.

    • Dr. Daniel Cameron
      08/26/2019 (12:07 pm)

      Thanks for your comments. The authors of the article I reviewed jumped to the conclusion that the pancreatitis was due to doxycycline. The blog reminded the reader that the pancreatitis was more likely due to the patient’s Type II diabetes and diabetic ketoacidoosis, both well-described causes of acute pancreatitis. That does not negate the possibility of doxycycline as an infrequent cause of pancreatitis. I have not seen pancreatitis due to doxycycline in my practice but I have seen pancreatitis due to other causes.

  • Sherry
    06/14/2019 (8:42 pm)

    I was on Doxycyline in January 2019 for pneumonia. After taking this medication and finishing it. The next day I was sick as a dog and thought I was dying. I was admitted in the hopsital for 5 days. I was diagnosed with Pancreatitis due to this medication. I wouldn’t advise anyone to take this drug. Not only was I sick from it, I lost a whole month of work and seeing a specialist once a week and mulitple Cat scans. DO NOT TAKE DOXYCYCLINE!!

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