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Clinician’s Corner: Pancreatic Enzymes

Your six-inch pancreas is quite a busy organ, producing close to 2 quarts of pancreatic juices that aid in digestion.  As discussed last week when the pancreas fails to produce adequate enzymes we see several symptoms of inappropriate digestion such as diarrhea, gas, unexplained weight loss and steatorrhea.

SOURCE: The digestive enzymes lipase, protease and amylase are extracted from the pancreas of pigs.    Both Muslim and Jewish leaders approve these pork derived enzymes if there are no other alternatives for treatment of the patient’s condition.


The initial dose of pancreatic enzyme replacement therapy (PERT) can be calculated by your doctor, based on your weight. Dosage adjustments thereafter are based on the following 3 factors:

  • degree of fat present in your bowel movements
  • content of dietary fat in the ingested meal
  • clinical symptoms of the disease

It may take 1-2 weeks for a patient to adjust their dose of the new PEP.

Patients usually take half of a mealtime dose for each substantial snack.

Approved Products include: Creon® (Abbvie), Zenpep® (Allergan), Pancreaze® (Janssen), Viokace® (Allergan), and Pertzye® (Digestive Care) are currently the only FDA-approved PEPs that are marketed in the United States


  • Take with every meal or snack or the symptoms of malabsorption may return.
  • Heat labile: Capsules must be swallowed with a cold drink, as a hot drink might weaken the enzymatic activity. Also, enzymes should not be carried in trouser pockets, due to body radiating heat.
  • The capsules should be swallowed whole and must not be crushed or chewed. If opened and sprinkled it should be on an acidic food (such as applesauce). Do not retain in the mouth, due to potential irritation of oral mucosa.
  • If you are having a large extended meal more than 2 courses, divide dose during the meal.
  • Because these medications may cost a couple of thousand dollars it is a good idea to call ahead 2 or 3 days ahead, so your enzymes are in stock.

Make sure you are keeping a journal of your bowel habits.  Your Thompson Pharmacist can provide you with information to help you get the most benefit from these expensive supplements.  Go Ahead and Ask…at Thompson Pharmacy it’s all for YOU!