Pancreatic Enzyme

Aka: Pancreatic Enzyme, Pancreatic Enzyme Replacement, Pancreatin, Oral Pancreatic Enzyme, Creon, Pancreaze, Zenpep, Ku-Zyme, Entozyme, Viokace

1. Indications
   1. Pancreatectomy
   2. Cystic Fibrosis
   3. Chronic Pancreatitis with Steatorrhea
      1. No evidence of reduced pain in Chronic Pancreatitis
   4. NOT indicated in other advertised indications as of 2021 (not indicated, no evidence, expensive)
      1. Avoid in Irritable Bowel Syndrome
      2. Avoid in Celiac Sprue
2. Preparations
   1. General
      1. Agents are not interchangeable
      2. Enteric coated agents are preferred
      3. Do not crush or chew tabs or microspheres
      4. Most agents are expensive ($1000 to $1500 per month)
   2. Brands (examples)
      1. Creon
      2. Pancreaze
      3. Zenpep
      4. Ku-Zyme
      5. Entozyme
      6. Viokace
         1. Not coated (take with Proton Pump Inhibitor)
3. Dosing
   1. Dose is titrated based on stool fat content
   2. Adults
      1. Starting dose: 8000 to 24,000 units Lipase (1-2 tabs) orally with meals and snacks
      2. Typical required dose is 40,000 units with meal and 20,000 units with snack
   3. Children
      1. Age <1 year: 2000 units Lipase with meals
      2. Age 1-6 years: 4000 to 8000 units Lipase with meals
      3. Age 7-12 years: 4000 to 12000 units Lipase with meals
4. Drug Interactions
   1. Avoid with Calcium Carbonate or Magnesium Hydroxide (Antacids)
      1. May impact enteric coating of Pancreatin
5. References
   1. Tarascon Pharmacopeia, IOS App, accessed 2/3/2021
   2. (2021) Presc Lett 28(2): 11