Thepancreasis an organ in the abdomen that is located behind the stomach.
It makes enzymes and hormones that help in the digestion of food.
When the pancreas doesnt produce enough of certain enzymes, its calledexocrine pancreatic insufficiency (EPI).
Illustration by Hilary Allison for Verywell Health
Illustration by Hilary Allison for Verywell Health
What Do Enzymes Do?
Enzymesthat the pancreas creates includeamylase,protease, andlipase.
They leave the pancreas through ducts and travel to the small intestine to help with the digestion of food.
Without these enzymes, food isnt digested properly.
This can result inmalabsorption.Malabsorptioncan cause unintended weight loss and many other complications, including fatigue and weakness.
The functions of these enzymes include:
What Is Pancreatic Enzyme Replacement Therapy?
The medications prescribed will contain the enzymes amylase, lipase, and protease.
They are approved by the Food and Drug Administration (FDA) to treat pancreatic insufficiency.
Its important to have the right dosing to ensure that food is digested.
Symptoms may start out mild and get worse over time as fewer and fewer enzymes are produced.
Working closely with a healthcare provider to look for the cause of symptoms is important to getting treatment.
There are many types of digestive enzymes that are sold over the counter.
These are not the same as medications for EPI and may not contain the right mix of enzymes.
The generic name for these enzymes ispancrelipase.
The most common cause ischronicpancreatitis, a long-term inflammation of the pancreas.
Some of the causes include:
Proper Dosage
Dosing of medication for EPI is important.
It might be challenging to work out the right dosage.
There isnt a consensus among experts about dosing across the different formulations.
For children, the dose might be given based on body weight in kilograms.
It might be recommended to start at a low dose and increase if and when needed.
The enzymes need to be taken at the start of a meal or a snack.
The capsules should be swallowed whole.
If they are chewed or crushed, they could irritate the mouth.
Its usually recommended that people swallow the capsules with a cold drink rather than a hot one.
Talk to a dietitian or healthcare provider about which foods to use when taking enzymes this way.
Its recommended to finish a meal within 15 minutes after the enzymes are taken.
Taking Pancreatic Enzymes
Take enzymes at the start of a meal or snack.
Split the dose if a meal will be longer than 30 minutes.
Swallow the capsules with a cold drink.
Open or crush the capsules unless instructed to by a healthcare provider.
Wait until during or after a meal or snack to take the enzymes.
Swallow the capsules with a hot drink.
Possible Side Effects
In general, there arent many side effects of PERT.
Any difficulty using the medication usually comes when people are not taking enough enzymes.
Its possible to take too high of a dose of pancreatic enzymes.
An overdose may cause a condition calledfibrosing colonopathy.
This has been seen in children who live with cystic fibrosis.
Dosing is important, especially in children, so that give the correct amount.
There may be an element of trial and error while understanding how to manage EPI and enzyme replacement.
Summary
PERT is an important part of managing EPI.
Some manufacturers might have patient assistance programs.
hit up the manufacturer of your drug or ask your healthcare provider or pharmacist about assistance programs.
For people who have insufficiency, its important to take the enzymes for as long as needed.
This treatment is considered both safe and effective.
No, pancreatic enzymes are not sold over the counter in drugstores or vitamin or health food stores.
EPI isconsidered a lifelong condition.
For this reason, its also likely that PERT will be needed throughout your lifetime.
AbbVie Inc.CREON [package insert].
Brennan GT, Saif MW.Pancreatic enzyme replacement therapy: A concise review.JOP.
