Recommended Dosage of Creon for Pancreatic Insufficiency
For adults with pancreatic insufficiency, the recommended initial dose of Creon (pancrelipase) is 500 units of lipase per kg per meal (approximately 40,000 units for an 80 kg patient) and 250 units of lipase per kg per snack (approximately 20,000 units for an 80 kg patient). 1
Dosing Guidelines
Initial Dosing
- Main meals: 500 units of lipase/kg/meal
- Example: 40,000 units for an 80 kg patient
- Snacks: 250 units of lipase/kg/snack
- Example: 20,000 units for an 80 kg patient
Dose Titration
- Titrate dose upward based on:
- Reduction in steatorrhea
- Improvement in gastrointestinal symptoms
- Weight gain
- Nutritional parameters
Maximum Dosing
- Maximum dose: 2,500 units of lipase/kg/meal
- Daily maximum: 10,000 units of lipase/kg/day
Administration Guidelines
- Take Creon during meals, not before or after
- Capsules should be swallowed whole with adequate fluid
- For patients unable to swallow capsules, contents can be sprinkled on soft acidic food (e.g., applesauce)
- Do not crush or chew the capsules or their contents
Available Formulations of Creon
Creon is available as enteric-coated microspheres in the following lipase strengths (USP units) 1:
- 3,000
- 6,000
- 12,000
- 24,000
- 36,000
Monitoring Efficacy
Successful treatment with Creon should be assessed by 1:
- Reduction in steatorrhea and GI symptoms
- Weight gain and improved muscle mass/function
- Improved fat-soluble vitamin levels
- Reduced stool frequency and improved consistency
Clinical Considerations
Factors Affecting Dosing
- Severity of pancreatic insufficiency
- Fat content of meals
- Body weight
- Individual response to therapy
Common Pitfalls to Avoid
- Inadequate dosing: Many patients are underdosed, leading to persistent symptoms
- Incorrect timing: Taking enzymes before or after meals reduces efficacy
- Failure to adjust for meal size: Larger, higher-fat meals require higher doses
- Not monitoring response: Regular assessment of nutritional status and symptoms is essential
Special Considerations
- In patients with persistent symptoms despite adequate dosing, consider:
- Adding proton pump inhibitors or H2 blockers to reduce gastric acid that can inactivate enzymes
- Evaluating for other causes of malabsorption (celiac disease, bacterial overgrowth)
- Assessing compliance with therapy
Evidence of Efficacy
Clinical trials have demonstrated that Creon significantly improves fat absorption and nutritional parameters in patients with pancreatic exocrine insufficiency. In a one-year study, patients showed significant improvements in coefficient of fat absorption (CFA), body weight, BMI, and nutritional laboratory parameters 2. Another study demonstrated that Creon treatment resulted in a significant increase in CFA from 58.0% at baseline to 84.7% after two weeks of treatment 3.
In patients with exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatic surgery, Creon significantly improved fat and nitrogen absorption compared to placebo, with similar rates of adverse events 4.