Pancrelipase

A to Z Drug Facts

(pan-KREE-lih-pace)

Creon 5, Capsules, delayed-release, 5000 U lipase/18,750 U protease/16,600 U amylase, Creon 10, Capsules, delayed-release, 10,000 U lipase/37,500 U protease/33,200 U amylase, Creon 20, Capsules, delayed-release, 20,000 U lipase/75,000 U protease/66,400 U amylase, Kutrase, Capsules, 2400 U lipase/30,000 U protease/30,000 U amylase, Ku-Zyme, Capsules, 1200 U lipase/15,000 U protease/15,000 U amylase, Ku-Zyme HP, Capsules, 8000 U lipase/30,000 U protease/30,000 U amylase/lactose, Lipram 4500, Capsules, delayed-release, 4500 U lipase/25,000 U protease/20,000 U amylase, Lipram-CR5, Capsules, delayed-release, 5000 U lipase/18,750 U protease/16,600 U amylase, Lipram-CR10, Capsules, delayed-release, 10,000 U lipase/37,500 U protease/33,200 U amylase, Lipram-CR20, Capsules, delayed-release, 20,000 U lipase/75,000 U protease/66,400 U amylase, Lipram-PN10, Capsules, delayed-release, 10,000 U lipase/30,000 U protease/30,000 U amylase, Lipram-PN16, Capsules, delayed-release, 16,000 U lipase/48,000 U protease/48,000 U amylase, Lipram-PN20, Capsules, delayed-release, 20,000 U lipase/44,000 U protease/56,000 U amylase, Lipram-UL12, Capsules, delayed-release, 12,000 U lipase/39,000 U protease/39,000 U amylase, Lipram-UL18, Capsules, delayed-release, 18,000 U lipase/58,500 U protease/58,500 U protease, Lipram-UL20, Capsules, delayed-release, 20,000 U lipase/65,000 U protease/65,000 U protease, Pancrease, Capsules, 4500 U lipase/25,000 U protease/20,000 U amylase, Pancrease MT 4, Capsules, 4000 U lipase/12,000 U protease/12,000 U amylase, Pancrease MT 10, Capsules, 10,000 U lipase/30,000 U protease/30,000 U amylase, Pancrease MT 16, Capsules, 16,000 U lipase/48,000 U protease/48,000 U amylase, Pancrease MT 20, Capsules, 20,000 U lipase/44,000 U protease/56,000 U amylase, Pancrecarb MS-4, Capsules, delayed-release, 4000 U lipase/25,000 U protease/25,000 U amylase, Pancrecarb MS-8, Capsules, delayed-release, 8000 U lipase/45,000 U protease/40,000 U amylase, Pancrelipase, Capsules, 4500 U lipase/25,000 U protease/20,000 U amylase, Tablets, 8000 U lipase/30,000 U protease/30,000 U amylase, Capsules, 16,000 U lipase/48,000 U protease/48,000 U amylase, Tablets, 16,000 U lipase/60,000 U protease/60,000 U amylase, Panokase, Tablets, 8000 U lipase/30,000 U protease/30,000 U amylase, Plaretase 8000, Tablets, 8000 U lipase/30,000 U protease/30,000 U amylase, Ultrase, Capsules, 4500 U lipase/25,000 U protease/20,000 U amylase, Ultrase MT 12, Capsules, 12,000 U lipase/39,000 U protease/39,000 U amylase, Ultrase MT 18, Capsules, 18,000 U lipase/58,500 U protease/58,500 U protease, Ultrase MT 20, Capsules, 20,000 U lipase/65,000 U protease/65,000 U protease, Viokase, Powder, 16,000 U lipase/60,000 U protease/60,000 U amylase, Viokase 8, Tablets, 8000 U lipase/30,000 U protease/30,000 U amylase, Viokase 16, Tablets, 16,000 U lipase/60,000 U protease/60,000 U amylase,  Creon 8, Creon 10, Creon 25, Digess 8000, Pancrease MT, Ultrace, Ultrace MT

Class: Digestive enzyme

 Action Helps to digest and absorb fats, proteins, and carbohydrates from food.

 Indications Enzyme replacement therapy in patients who do not produce enough pancreatic enzymes because of cystic fibrosis, chronic pancreatitis, postpancreatectomy, ductal obstructions caused by cancer of pancreas or common bile duct, pancreatic insufficiency; treatment of steatorrhea of malabsorption syndrome; postgastrectomy or after GI surgery; pancreatic function testing.

 Contraindications Hypersensitivity to pork protein or enzymes; acute pancreatitis; acute exacerbations of chronic pancreatic disease.

 Route/Dosage

Dosage is adjusted based on severity of the exocrine pancreatic enzyme deficiency. Dosage recommendation varies with the brand and formulation. Take capsules or tablets with meals or snacks.

Ku-Zyme, Pancrecarb, Ultrase, Ultrase MT Adults PO Start with 1 or 2 capsules with each meal or snack.

Kutrase Adults PO Take 1 capsule with each meal or snack.

Ku-Zyme HP PO Take 1 to 3 capsules with each meal or snack. In severe deficiencies, increase the dose to 8 capsules with meals or increase the frequency to hourly intervals if nausea, cramps, or diarrhea do not occur.

Pancrease, Pancrease MT 4 Children over 4 yr PO Start with 400 lipase U/kg/meal up to a max of 2500 lipase U/kg/meal.

Children under 4 yr PO Start with 1000 lipase U/kg with each meal up to a max of 2500 lipase U with each meal.

Children up to 12 mo PO 2000 to 4000 lipase U/120 mL of formula or breast milk.

Pancrelipase, Lipram Adults PO 4000 to 20,000 lipase U with each meal and with snacks.

Children 7 to 12 yr PO 4000 to 12,000 lipase U with each meal and with snacks.

Children 1 to 6 yr PO 4000 to 8000 lipase U with each meal and 4000 U with each snack.

Children 6 mo to under 1 yr PO 2000 lipase U with each meal.

Creon 5 Adults and children over 6 yr PO Usual starting dose is 2 to 4 capsules with each meal or snack.

Children under 6 yr PO Start with 1 to 2 capsules with each meal or snack. Select exact dose based on clinical experience with this age group.

Cystic fibrosis patients PO Usual doses are 1500 to 3000 lipase U/kg with each meal (max, 6000 lipase U/kg/meal).

Creon 10 Adults and children over 6 yr PO Usual starting dose is 1 to 2 capsules with each meal or snack.

Children under 6 yr PO Usual starting dose is up to 1 capsule with each meal or snack.

Cystic fibrosis patients PO Usual doses are 1500 to 3000 lipase U/kg with each meal (max, 6000 lipase U/kg/meal).

Creon 20 Adults and children over 6 yr PO Start with 1 capsule with each meal or snack.

Children under 6 yr PO Select exact dose based on clinical experience with this age group.

Cystic fibrosis patients PO Usual starting doses are 1500 to 3000 lipase U/kg with each meal (max, 6000 lipase U/kg/meal).

Panokase, Plaretase, Viokase (tablets) Cystic fibrosis and chronic pancreatitis patients PO Dose ranges from 8000 to 32,000 lipase U (1 to 4 tablets [Plaretase, Panokase, Viokase 8 ] or 1 to 2 tablets [Viokase 16 ]) with each meal.

Pancreatectomy or obstruction of pancreatic ducts PO 1 to 2 tablets (Plaretase, Panokase, Viokase 8 ) or 1 tablet (Viokase 16 ) q 2 hr.

Viokase (powder) Cystic fibrosis PO 0.7 g (1/4 tsp) with each meal.

 Interactions

Antacids: Calcium carbonate or magnesium hydroxide may negate beneficial effect of enzymes.

Iron: Serum iron response to oral iron may be decreased with concomitant pancreatic enzyme administration.

 Lab Test Interferences None well documented.

 Adverse Reactions

DERMATOLOGIC: Perianal irritation. GI: Colonic strictures; diarrhea; abdominal pain; intestinal obstruction; vomiting; intestinal stenosis; constipation; flatulence; nausea; bloating; cramping. OTHER: Hypersensitivity reaction.

 Precautions

Pregnancy: Category B (Pancrease, Pancrease MT ); Category C (Creon, Ku-Zyme, Ku-Zyme HP, Kutrase, Lipram, Pancrelipase, Panokase, Plaretase, Ultrase, Ultrase MT, Viokase ). Lactation: Undetermined. Asthma: Inhalation of airborne pancrelipase powder can precipitate asthma attack. Colonic strictures: Colonic strictures reported primarily in cystic fibrosis patients often at dosages above the recommended range. Skin irritation: Contact of pancrelipase with skin can cause irritation.

 Administration/Storage

• Do not crush or allow patient to chew enteric-coated formulations.
• Give with or before meals.
• If powder spills on hands, wash with soap and water immediately.
• If patient has difficulty swallowing capsule, open capsule and shake onto small quantity of soft, non-hot food (eg, applesauce, gelatin) that does not require chewing. Have patient swallow immediately without chewing to avoid irritating GI mucosa. Follow with glass of juice or water.
• Be careful not to inhale powder, which can irritate mucosal surfaces and cause asthma attack.
• Store at room temperature in tightly closed container. Protect from moisture.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess bowel status before and during treatment.
• Maintain growth chart on children.
• Assess for steatorrhea.
• If symptoms of sensitivity occur, discontinue drug and initiate symptomatic and supportive therapy.
• If nausea, abdominal cramps, or diarrhea develop, notify health care provider.

 Patient/Family Education

• Tell patient not to change brands without notifying health care provider. Products are not bioequivalent.
• Advise patient not to take pancrelipase with antacid containing calcium carbonate or magnesium hydroxide.
• Stress to patient the importance of taking drug before or with meals to enhance effectiveness of drug.
• Instruct patient to avoid inhaling powder to reduce chance of irritating mucous membranes or precipitating asthma attack.
• Advise patient to follow any special dietary recommendations from health care provider or dietitian.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts