What is the starting dose of Creon (pancrelipase) in units of lipase?

Starting Dose of Creon (Pancrelipase) in Lipase Units

The initial recommended dosage of Creon (pancrelipase) is 500 units of lipase per kg per meal (approximately 40,000 units for an 80 kg adult) and 250 units of lipase per kg per snack (approximately 20,000 units for an 80 kg adult). 1

Dosing Guidelines by Age Group

Adults

• Initial dose: 40,000 USP units of lipase with each meal 2
• Snack dose: 20,000 USP units of lipase (half the meal dose) 2
• Alternative dosing approach: 500 lipase units/kg/meal, titrating upward as needed 2
• Maximum dose:
  • 2,500 lipase units/kg/meal
  • 10,000 lipase units/kg/day
  • 2,000-4,000 lipase units/gram of dietary fat 2

Children

• Children >4 years: Same as adult dosing (starting at 500 lipase units/kg/meal) 2
• Children 1-4 years: 2,000-4,000 lipase units/gram of dietary fat 2
  • Maximum: 10,000 lipase units/kg/day
• Infants (up to 12 months): 2,000-4,000 lipase units/120 mL formula or estimated breast milk intake 2
  • Approximately 2,000 lipase units/gram dietary fat in food

Administration Guidelines

• PERT must be taken during meals, not before or after, to maximize mixing with food and digestion of nutrients 2
• Capsules should be swallowed whole or opened and sprinkled on soft, acidic foods (not crushed or chewed) 1
• Creon treats the meal, not the pancreas - dosage should be adjusted based on:
  • Meal size
  • Fat content of the meal
  • Severity of pancreatic insufficiency 2, 1

Available Strengths of Creon

Creon is available as enteric-coated microspheres in the following lipase strengths (USP):

• 3,000
• 6,000
• 12,000
• 24,000
• 36,000 2

Monitoring and Dose Adjustment

• Measure treatment response to ensure adequate dosing and proper administration
• Successful treatment is indicated by:
  • Reduction in steatorrhea and gastrointestinal symptoms
  • Weight gain/maintenance
  • Improvement in fat-soluble vitamin levels 2, 1
• Consider adding a proton pump inhibitor or H2 blocker if response is inadequate despite proper dosing 2

Common Pitfalls to Avoid

1. Inadequate dosing: Starting with too low a dose may not adequately control malabsorption
2. Improper timing: Taking enzymes before or after meals rather than during meals
3. Failure to adjust dose: Not increasing dose based on meal fat content
4. Using over-the-counter enzymes: These are unregulated with unknown efficacy and safety 1
5. Failure to recognize treatment failure: If symptoms persist despite adequate dosing and PPI addition, consider other causes of malabsorption 1

Remember that untreated exocrine pancreatic insufficiency can lead to malnutrition, fat-soluble vitamin deficiencies, poor quality of life, and increased mortality 2. Proper dosing of pancreatic enzyme replacement therapy is essential for preventing these complications.