What are the alternatives to Creon (Pancrelipase)?

From the Guidelines

The main alternatives to Creon are other prescription pancreatic enzyme replacement therapies (PERTs) such as Zenpep, Pancreaze, or Pertzye, as listed in the US Food and Drug Administration–Approved Formulations of Pancreatic Enzyme Replacement Therapy 1. These medications contain similar enzymes (lipase, amylase, and protease) and are used to treat pancreatic insufficiency in conditions like cystic fibrosis, chronic pancreatitis, or after pancreatic surgery. The choice between these alternatives depends on individual patient factors and should be made in consultation with a healthcare provider. Some key points to consider when selecting an alternative to Creon include:

• The type of formulation: enteric-coated microspheres (Creon, Pertzye), enteric-coated beads (Zenpep), or enteric-coated microtablets (Pancreaze) 1
• The available lipase strengths: ranging from 2,600 to 40,000 USP units per dose 1
• The need for H2 receptor antagonist or proton pump inhibitors with non–enteric-coated preparations, such as Viokace 1 Dosing varies based on the specific product and patient needs, typically starting with 500 lipase units per kg of body weight per meal for adults, with adjustments based on meal size and fat content 1. These alternatives work similarly to Creon by replacing the digestive enzymes normally produced by the pancreas, helping to break down fats, proteins, and carbohydrates in food. While over-the-counter digestive enzymes exist, they are generally less potent and not recommended as a direct substitute for prescription PERTs in cases of significant pancreatic insufficiency. Monitoring of fat-soluble vitamin levels and nutritional status is essential in patients with exocrine pancreatic insufficiency (EPI), and treatment with PERT should be adjusted based on individual patient response 1. Regular follow-up assessments, including annual updates of measurements of fat-soluble vitamins and serum markers of malnutrition, are necessary to ensure optimal management of EPI 1.

From the Research

Alternatives to Creon (Pancrelipase)

There are several alternatives to Creon (Pancrelipase) for the treatment of exocrine pancreatic insufficiency, including:

• Zenpep (APT-1008) 2
• Kreon 2, 3
• Panpur 3

Comparison of Alternatives

Studies have compared the efficacy and safety of these alternatives, including:

• A randomized, double-blind, crossover, non-inferiority study comparing Zenpep and Kreon in patients with cystic fibrosis-associated exocrine pancreatic insufficiency, which found that Zenpep was non-inferior and equivalent to Kreon in fat absorption 2
• A comparative study of Kreon and Panpur, which found that Creon was more effective in replacing pancreatic enzymes due to its good mixing with meals and stability of lipase against proteolytic splitting 3

Key Considerations

When considering alternatives to Creon, key factors to consider include:

• Efficacy in improving fat absorption and nutritional status
• Safety and tolerability
• Individual patient needs and response to treatment
• Potential for drug interactions and side effects 4, 5