Everything you need to know about pancreatic enzymes
Pancreatic enzyme supplementation, or pancreatic enzyme replacement, is often needed in patients with chronic pancreatitis and cystic fibrosis. These medical conditions result in the pancreas either not producing enough pancreatic enzymes or the enzymes get blocked from reaching the digestive tract.
You need a sufficient amount of pancreatic enzymes to break-down your food so that it can be absorbed. Pancreatic enzymes can help avoid weight loss and may improve pain.
There are many prescription pancreatic enzyme products in Canada. Each has a different brand name and a unique dosage of enzymes. That’s why you need to know exactly which product and the dosage that you should be taking. Mistakes can occur in the prescribing, dosing, and dispensing of these medicines, particularly when you are admitted to or discharged from the hospital.
Today I’m reviewing the pancreatic enzyme products that require a doctor’s prescription. You will find a variety of “natural health product” enzymes that you can purchase over-the-counter. I do not recommend these products since they are unregulated and may be of questionable quality.
Source of pancreatic enzymes
All of the prescription enzymes are derived from pork (pig) pancreas that is used for human consumption. If you are allergic to pork you should not consume these medications.
How to correctly take pancreatic enzymes
Do not crush or chew your pancreatic enzyme products. The capsule products can be opened and sprinkled on food as required or administered down a feeding tube.
Take your pancreatic enzymes just before the first bite of every meal or snack. Swallow the product whole with sufficient fluid. If you forget to take your enzyme take it as soon as you remember if you are still eating. Otherwise, resume your regular dosing with your next meal or snack.
How to store pancreatic enzymes
Store your enzymes in their original container at room temperature (20-25°C). Don’t store in the fridge.
Each pancreatic enzyme product has a particular brand name. They frequently have a number that refers to the quantity of lipase contained in the product.
Ask your pharmacist to dispense an entire bottle of your enzymes in their original container. Always double check to ensure you have been prescribed and dispensed the correct product.
Enteric coating and gastro-resistant mean the same thing. These terms refer to is the fact that the medication is not released in your stomach, but released only once it passes into your small intestine. The small intestine has a basic pH, which allows for the enzymes to be active in breaking down your food.
For non-enteric coated products (ViokaceTM or Cotazym® capsules), you should also be taking a medication called a proton pump inhibitor, which reduces the level of stomach acid. Examples of proton pump inhibitors include lansoprazole, omeprazole, pantoprazole, esomeprazole, rabeprazole, and dexlansoprazole.
The Drug Information Number (DIN) will help you identify each unique product on the Health Canada website or with your insurance company. It can also serve as a double-check when you pick-up your pancreatic enzymes from the pharmacy.
Regular release capsule
Cotazym® Capsule (lipase 10,000 units/ amylase 40,00 units/ protease 35,00 units), DIN 00263818.
Enteric coated microsphere capsules
Cotazym® ECS 8 (lipase 10,800 units/ amylase 42,000 units/ protease 45,000 units), DIN 00502790.
Cotazym® ECS 20 (lipase 25,000 units/ amylase 100,000 units/ protease 100,000 units), DIN 00821373.
Gastro-resistant granules for infants and children
Creon Minimicrospheres® Micro (lipase 5,500 units/ amylase 5,100 units/ protease 320 units), DIN 02445158.
Capsules containing gastro-resistant granules
Creon Minimicrospheres® 6 (lipase 6,000 units/ amylase 30,000 units/ protease 19,000 units), DIN 02415194.
Creon Minimicrospheres® 10 (lipase 10,000 units/ amylase 11,200 units/ protease 730,000 units), DIN 02200104.
Creon Minimicrospheres® 25 (lipase 25,000 units/ amylase 30,000 units/ protease 19,000 units), DIN 01985205.
Delayed-release capsules with enteric coated microtablets
Pancrease® MT 4 (lipase 4,200 units/ amylase 17,500 units/ protease 10,000 units), DIN 00789445.
Pancrease® MT 10 (lipase 10,500 units/ amylase 43,750 units/ protease 25,000 units), DIN 00789437.
Pancrease® MT 16 (lipase 16,800 units/ amylase 70,000 units/ protease 40,000 units), DIN 00789429.
Regular release tablets
ViokaceTM (lipase 10,440 units/ amylase 56,400 units/ protease 57,100 units), DIN 02230019.
ViokaceTM (lipase 20,880 units/ amylase 113,400 units/ protease 112,500 units), DIN 02241933. Note this product contains double the quantity of each enzyme. Your prescriber should specify the product or dose in units of lipase.
In recognition of Pharmacist Awareness Month (March), I’m thanking my many pharmacist mentors who have generously shared their time, their perspective, and their advice with me. You have each contributed to my growth as a person and as a pharmacist.
I encourage each of you to take a moment to recognize any pharmacists in your life who have helped you achieve better health or helped you get the most from your medications.
So here is a sincere thank you to my pharmacist mentors! In no particular order:
- Sheri Koshman
- Cindy McMinis
- Natasha Krahn
- Barry Power
- Eddie Wong
- Aileen Jang
- Cheryl Sadowski
- Monica Zollezi
- Azmina Suleman
- Margaret Gray
- Alice Chan
- Tracey Lawson
- Steve Freriks
- Elizabeth Mathews
- Sheila Walter
- Christine Ontko
- Mary Gunther
- Julie Pellerin
- Rita Pon
- Jenny Shiu