Pancreatic enzyme replacement therapy (PERT) is the use of medications that contain enzymes to replace what the pancreas is no longer making or releasing. These medications contain proteases to digest protein, amylases to digest carbohydrates and lipases to digest fat. Digestion of protein, carbohydrates and fats helps prevent malabsorption.
Dosing
Dosing based on weight
Dosing based on grams of fat eaten
Dosing considerations
- Pancreatin is inactivated by gastric acid so dose should be taken whole or contents mixed with acidic fluid or soft food (then swallowed immediately without chewing)
- Enteric-coated preparations deliver a higher enzyme concentration in the duodenum (provided the capsule contents are swallowed whole without chewing)
- Gastro-resistant granules should be mixed with slightly acidic soft food or liquid such as apple juice, and then swallowed immediately without chewing.
- Capsules containing enteric-coated granules can be opened and the granules administered in the same way.
- Take immediately before starting to eat
- Review after 4 weeks
- The correct dose is that which controls bowel symptoms and maintains good nutritional status in the individual patient
- Total daily dose should not exceed 10,000 lipase units/kg body weight/day unless clinically indicated
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People experiencing steatorrhea (fatty stools) may become deficient in fat soluble vitamins (vitamins A, D, E and K)
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Pancreatic enzymes are extracted from the pig pancreases so may be concerning to certain religions and vegetarians/vegans
Pancreatic enzyme brands & dose instructions
| Brand | Child dose | Adult dose | Additional Info |
| Creon |
2-17 yrs Initially 1–2 capsules with each meal |
Initially 1–2 capsules with each meal | taken whole or contents mixed with acidic fluid or soft food (then swallowed immediately without chewing). |
| Creon Micro | Initially 100 mg | Initially 100 mg |
For infants, can be mixed with a small amount of milk on a spoon and administered immediately—granules should not be added to the baby's bottle.
|
| Pancrease HL |
Should not be used in children aged 15 years or less with cystic fibrosis For Child 15–17 years Initially 1–2 capsules, dose to be taken during each meal and 1 capsule, to be taken with snacks |
Initially 1–2 capsules, dose to be taken during each meal and 1 capsule, to be taken with snacks | taken whole or contents mixed with slightly acidic liquid or soft food (then swallowed immediately without chewing). |
| Nutrizym 22® GR capsules | Should not be used in children aged 15 years or less with cystic fibrosis | Initially 1–2 capsules, dose to be taken with meals and 1 capsule as required, dose to be taken with snacks | swallowed whole or contents taken with water, or mixed with acidic fluid, such as apple juice or soft food (then swallowed immediately without chewing |
| Pancrex V |
For Child 1–11 months 1–2 capsules, contents of capsule to be mixed with feeds. For Child 1–17 years 2–6 capsules, dose to be taken with each meal either swallowed whole or sprinkled on food. |
2–6 capsules, dose to be taken with each meal either swallowed whole or sprinkled on food. | |
| Pancrex V Powder | 0.5–2 g, to be taken before or with meals, washed down or mixed with milk or water. | 0.5–2 g, to be taken before or with meals, washed down or mixed with milk or water. | may be administered via nasogastric tube or gastrostomy tube |
