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Pancreatic Enzyme Supplement Pregnancy: Compatible — PERT is essential treatment; EPI must be treated in pregnancy to prevent malnutrition.

Pancreatin (Pancreatic Enzyme Replacement Therapy — PERT)

Brand names: Creon, Nutrizym, Pancrease HL

Adult dose

Dose: Initially Creon 10,000 (10,000 units lipase) with each main meal and 5,000 units with snacks. Titrate upward based on stool fat and symptoms. Typical maintenance: Creon 25,000–40,000 per meal.
Route: Oral (capsules — swallow whole or open and sprinkle on acidic food; do not crush granules)
Frequency: With every meal and snack
Max: 10,000 units lipase/kg/day or 4,000 units lipase/g dietary fat/day (risk of fibrosing colonopathy above this threshold)
For exocrine pancreatic insufficiency (EPI): cystic fibrosis, chronic pancreatitis, pancreatectomy, pancreatic cancer. Dose by lipase units — different brands are NOT interchangeable (different enzyme ratios). Creon preparations: Creon 10,000, 25,000, 40,000 (lipase units per capsule).

Paediatric dose

Route: Oral
Frequency: With every feed or meal
Max: 10,000 units lipase/kg/day
BNF for Children: Infants (CF): Creon Micro granules — 100mg (5,000 units lipase) mixed into small amount of milk/apple puree per 100mL feed. Children: 500–4,000 units lipase/g fat per meal; start low and titrate. Do NOT exceed 10,000 units lipase/kg/day — fibrosing colonopathy risk. Source: BNF for Children 2024; CF Trust PERT Guidelines.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

No dose adjustment required.

Clinical pearls

  • Fibrosing colonopathy: dose-limiting serious complication in CF children — caused by high-strength preparations at excessive doses. Never exceed 10,000 units lipase/kg/day.
  • Opening capsules: Creon capsules can be opened and granules sprinkled on acidic food (e.g., apple purée, yoghurt) — do NOT crush granules (destroys enteric coating). Useful for patients who cannot swallow capsules.
  • Three-day faecal fat test or faecal elastase-1: used to confirm EPI and assess response to PERT.
  • Brands NOT interchangeable: Creon, Nutrizym, Pancrease HL have different enzyme ratios — prescribe by brand name.

Contraindications

  • Known hypersensitivity to porcine (pig) proteins (pancreatin is porcine-derived)

Side effects

  • Abdominal discomfort, nausea (at high doses)
  • Constipation or diarrhoea (dose-dependent)
  • Oral and perianal irritation (if granules contact mucosa directly)
  • Fibrosing colonopathy (with prolonged use of >10,000 units lipase/kg/day — particularly in children with CF)
  • Hyperuricosuria and hyperuricaemia (at very high doses)

Interactions

  • Acarbose: pancreatin theoretically reduces effect of acarbose (degrades acarbose in gut) — clinical significance uncertain

Monitoring

  • Stool consistency (aim for formed, non-fatty stools — no steatorrhoea)
  • Weight and nutritional status
  • Fat-soluble vitamin levels (A, D, E, K — deficient in EPI)
  • Faecal elastase-1 (diagnosis and monitoring of EPI)
  • Dose (ensure below 10,000 units lipase/kg/day safety limit)

Reference: BNFc; BNF 90; Cystic Fibrosis Trust — PERT Guidelines; SPC Creon. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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