From the Guidelines
Creon is a pancreatic enzyme replacement therapy (PERT) used to treat exocrine pancreatic insufficiency (EPI), with a recommended initial dose of at least 40,000 USP units of lipase during each meal in adults and one-half of that with snacks, as supported by the most recent evidence 1.
Key Points
- The medication contains lipase, protease, and amylase enzymes that help digest fats, proteins, and carbohydrates, respectively.
- Patients should take Creon with meals and snacks, with capsules swallowed whole or opened and sprinkled on soft, non-hot food.
- The primary goal of PERT is to ensure adequate digestion of lipids to meet macro-nutritional needs, with a secondary goal to reduce steatorrhea and intestinal symptoms that may be diet-related.
- Dose adjustments may be necessary based on nutritional status, symptom control, and stool characteristics, as well as meal size and fat content.
- Common side effects include abdominal pain, gas, and headache, and extremely high doses have been associated with fibrosing colonopathy, so dosing should follow established guidelines and be monitored by healthcare providers 1.
Important Considerations
- The use of PERT in patients with chronic pancreatitis and EPI improves outcomes, and it is also an essential part of managing EPI and nutrition in the setting of cystic fibrosis 1.
- Routine supplementation monitoring of fat-soluble vitamin levels is appropriate, and dietary modifications include a low-moderate fat diet with frequent smaller meals and avoiding very-low-fat diets 1.
- Over-the-counter commercially available pancreas enzyme replacements should not be used, as they are classified as dietary supplements only and their dosing and efficacy are neither standardized nor regulated 1.
From the Research
Definition and Purpose of Creon
- Creon, also known as pancrelipase, is a pancreatic enzyme replacement therapy (PERT) used to treat exocrine pancreatic insufficiency (EPI) due to conditions such as chronic pancreatitis, pancreatic surgery, or cystic fibrosis 2, 3.
- The primary purpose of Creon is to prevent severe maldigestion, malnutrition, and unwanted weight loss associated with EPI by replacing the deficient pancreatic enzymes 2, 4.
Mechanism of Action and Efficacy
- Creon works by providing a combination of enzymes, including lipase, amylase, and trypsin, which help to break down fats, carbohydrates, and proteins in the diet 5, 6.
- Studies have shown that Creon is effective in improving fat and nitrogen absorption, reducing stool frequency and abdominal pain, and promoting weight gain in patients with EPI 2, 3, 4.
- The efficacy of Creon has been demonstrated in various clinical trials, including double-blind, randomized, placebo-controlled studies 3, 4.
Safety and Tolerability
- Creon has been shown to be well-tolerated and safe in patients with EPI, with a low frequency of adverse events and few treatment-related discontinuations 2, 3, 4.
- Common adverse events associated with Creon include gastrointestinal disorders and allergic skin reactions 3.
- Long-term safety and efficacy of Creon have been demonstrated in open-label extension studies 2.