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Case 4: Didanosine-Associated Pancreatitis

You answered:

C The risk of didanosine-induced pancreatitis is dose-related. The patient in this case had an increased risk of developing pancreatitis because tenofovir likely increased didanosine levels. The didanosine dose should have been decreased to 250 mg per day.

This answer is correct. Several studies have clearly shown greater risk of pancreatitis with higher doses of didanosine. Tenofovir increases the area under the curve (AUC) of didanosine by 48 to 60%, which increases the dose-dependent risk of mitochondrial toxicity and clinical pancreatitis. In patients who weigh more than 60 kg, the dose of didanosine EC should be decreased to 250 mg per day when co-administered with tenofovir.


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