Pancreatic Enzyme Replacement Therapy (PERT)

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About Pancreatic Enzyme Replacement therapy

taking a pancreatic enzyme

Pancreatic enzyme replacement therapy involves taking the digestive enzymes you need in the form of a tablet. All enzyme supplements contain Pancreatin- a mixture of pancreatic enzymes, lipase, amylase and protease. These assist the digestion of fat, carbohydrates and proteins.

Enzyme doses vary from person to person. A starting dose is around 50,000 to 75,000 units of lipase with a meal and 25,000 units with a snack.

Pancreatic enzyme preparations include Creon®, Nutrizym®, Pancrease® and Pancrex®. They commonly come in 2 capsule sizes; 10,000 unit (mainly used in children) and 25,000-unit capsules. Each capsule has a different number or letter following the name to indicate the strength of the dose.

Most adults take either 2 or 4 of the 25,000-unit capsules per meal. Do not be alarmed by the high capsule units — the number relates to the amount of lipase units it contains. A healthy pancreas will release about 720,000 lipase units during every meal.

How should I take enzyme supplements?

You will need to take enough enzymes to allow your body to break down your food. Your dietitian will recommend the amount to take. Capsules should be taken with food directly- i.e. with the first mouthful of food. This includes meals, snacks and milky drinks including nutritional supplements. If you skip the enzymes or stop taking them then the symptoms of malabsorption may return. If you continually forget to take your enzymes it may affect your ability to have some treatments such as chemotherapy. If you are worried you might forget, try setting an alarm or asking a friend or family member to help prompt you.

Capsules must be swallowed whole with a cold drink. Swallowing them with a hot drink can make them less effective as enzymes are damaged at high temperatures.

If you are having a large meal, a long meal or more then two courses, you may need to take half of your enzymes at the beginning and the other half in the middle of your meal.

When NOT to take enzyme supplements

Can I vary the dose of the pancreatic enzymes myself?

While your doctor or dietitian will discuss what strength dose is best for you, you will be the best judge of your symptoms, so it may be appropriate for you to alter the dose yourself.

You do not need to restrict your diet when taking pancreatic enzymes but if you are eating a meal that is high in fat or experiencing malabsorption symptoms it may be necessary to adjust the dose of your pancreatic enzymes. You cannot take too many pancreatic enzymes; your body will excrete the excess in your next bowel movement.  Occasionally this may cause a little burning around the anus. If you are at all uncertain about what dose you should be taking, contact your doctor or dietitian.

Are there any side effects?

As some people will experience side effects from enzyme replacement, it is important that you read the medicine information leaflet produced by the manufacturers. The most frequent side effects are constipation, diarrhoea, nausea, and abdominal discomfort. These usually settle over time or, as the manufacturers use different coatings, it may be worth switching to a different brand of enzyme. Let your doctor know if you experience severe diarrhoea.

What if I have difficulty swallowing the capsules?

In this case it is possible to open the capsule and mix the granules (do not crush them) into an acidic fruit puree such as apple sauce or with yoghurt. This mixture needs to be swallowed straight away, without chewing.
It could be helpful to have a cold drink after this to help flush down any remaining enzyme granules and eating a snack or meal straight away.
It is also possible to ask for a lower-dose capsule which is smaller and easier to swallow. However, in order to get your required dose, you will need to take more of them.

My religion restricts me from eating pork, so can I still take pancreatic enzymes?

Pancreatic enzyme supplements are extracted from pig pancreas glands and there is currently no alternative to using pork products. However, it is important to know that for those who may have a religious objection to the ingestion of pork products, special dispensation to allow these products has been granted by religious organisations as they are a medicine.

Pancreatic enzymes have been approved for use by Jewish patients by the Chief Rabbi. For Muslim patients, Dr Abdul Hamid Mohamed, London Central Mosque Trust, has advised the following:

“If, and only if, no other medicines than the ones containing prohibited substances are suitable to cure the illness or disease in the opinion of the physician, then the medicine containing the prohibited substance should be prescribed and taken by the patient.”