Creon vs. Pancreoflat for Pancreatic Exocrine Insufficiency
Creon (pancrelipase) is the preferred initial treatment for pancreatic exocrine insufficiency (PEI) with a recommended starting dose of 500 units of lipase per kg per meal and 250 units of lipase per kg per snack. 1
Dosing and Administration Guidelines
Initial Dosing for Adults
- Start with 500 lipase units/kg/meal (typically 40,000-50,000 units/meal)
- Use 250 lipase units/kg/snack (typically 10,000-40,000 units/snack)
- Maximum dose: 2,500 lipase units/kg/meal or 10,000 lipase units/kg/day 1
Dosing for Children
- Over 4 years: Same as adult dosing (500 lipase units/kg/meal)
- 1-4 years: 2,000-4,000 lipase units/gram of dietary fat
- Infants up to 12 months: 2,000-4,000 lipase units/120 mL formula 1
Efficacy of Creon
Creon has demonstrated superior efficacy in multiple clinical trials:
- In patients with PEI due to chronic pancreatitis or pancreatic surgery, Creon significantly improved coefficient of fat absorption (CFA) by 31.9% compared to only 8.7% with placebo (P<0.0001) 2
- Creon also improved coefficient of nitrogen absorption (CNA) by 35.2% versus 8.9% with placebo (P=0.0005) 2
- In a study using Creon 40000 MMS, patients showed an 18.5% improvement in CFA compared to only 4.1% with placebo (P=0.001) 3
Clinical Considerations
Before Starting Treatment
- Confirm PEI diagnosis with fecal elastase-1 test and clinical evaluation 1
- Assess baseline nutritional status including:
- Body mass index (BMI)
- Fat-soluble vitamin levels (A, D, E, K)
- Serum markers of malnutrition 1
Lifestyle and Dietary Recommendations
- Advise patients to:
- Abstain from alcohol and tobacco
- Eat small, frequent meals rather than large meals
- Follow a low to moderate fat diet (avoid very low-fat diets) 1
Supplementation
- Routinely supplement fat-soluble vitamins (A, D, E, K) 1
Monitoring and Evaluation
- Evaluate treatment success through:
- Reduction in steatorrhea and diarrhea
- Improvement in abdominal pain
- Weight stabilization or gain
- Improved fat-soluble vitamin levels 1
- Annual assessment of:
- BMI
- Quality-of-life measures
- Fat-soluble vitamin levels
- Serum markers of malnutrition
- Screening for diabetes with HbA1c 1
Troubleshooting Inadequate Response
- If response remains inadequate despite proper dosing:
- Consider adding a proton pump inhibitor or H2 blocker to prevent acid denaturing of lipase 1
- Ensure proper timing of enzyme administration (with meals)
- Verify patient compliance with prescribed regimen
Common Pitfalls to Avoid
- Inadequate dosing
- Using over-the-counter enzymes instead of prescription products
- Failure to adjust dose based on meal size and fat content
- Not addressing alcohol consumption, which can worsen pancreatic function 1
Creon has demonstrated consistent efficacy and safety across multiple clinical trials for treating PEI due to various conditions including chronic pancreatitis, cystic fibrosis, and after pancreatic surgery 2, 4, 3. The evidence strongly supports its use as first-line therapy for PEI.