From the Guidelines
Alternatives to Creon (pancrelipase) for patients with pancreatic insufficiency include other pancreatic enzyme replacement therapy (PERT) brands such as Zenpep, Pancreaze, Pertzye, and Viokace, as listed in the US Food and Drug Administration–Approved Formulations of Pancreatic Enzyme Replacement Therapy table 1. These medications contain the same active ingredients as Creon (lipase, protease, and amylase) but may differ in their specific formulations, dosing, and release mechanisms. The choice of alternative depends on individual factors including insurance coverage, patient preference regarding capsule size, dosing flexibility, and specific formulation characteristics. Some key considerations for managing pancreatic insufficiency include:
- Taking enzymes with food to ensure they mix with stomach contents
- Starting with a typical dose of 500 lipase units per kg per meal, adjustable based on symptom control and nutritional status
- Considering non-PERT alternatives like dietary modifications, although these are generally less effective than enzyme replacement
- Monitoring nutritional status and adjusting treatment as necessary to prevent malnutrition and related complications, as emphasized in the AGA clinical practice update on the epidemiology, evaluation, and management of exocrine pancreatic insufficiency 1. In severe cases where malnutrition persists despite PERT, nutritional supplements or enteral feeding may be necessary, highlighting the importance of a comprehensive approach to managing pancreatic insufficiency, as discussed in the ESPEN guideline on clinical nutrition in acute and chronic pancreatitis 1.
From the FDA Drug Label
Do not substitute other pancreatic enzyme products for CREON When switching from another pancreatic enzyme product to CREON, monitor patients for clinical symptoms of exocrine pancreatic insufficiency and titrate the dosage as needed.
The FDA drug label does not answer the question.
From the Research
Alternatives to Creon
There are several alternatives to Creon (pancrelipase) for patients with pancreatic insufficiency, including:
- Zenpep®: a pancrelipase formulation approved by the FDA as an effective treatment for pancreatic exocrine insufficiency (PEI) 2
- Pancreaze®: another pancrelipase formulation approved by the FDA for the treatment of PEI 2, 3
- Other pancreatic enzyme replacement therapy (PERT) products: several new commercially available PERTs have demonstrated similar or slightly improved abilities to increase the absorption of fat and nitrogen compared to previous PERT preparations 3
Characteristics of Alternative Treatments
The alternative treatments to Creon have been shown to:
- Improve the absorption of fat and nitrogen in patients with pancreatic insufficiency related to cystic fibrosis 3
- Have similar side-effect profiles compared to placebo 4, 3
- Require individualized dosing and titration based on patient response and weight gain 3, 5
Considerations for Treatment
When considering alternative treatments to Creon, it is essential to: