Recommended Dosage of Pancreipase for Patients with Pancreatic Insufficiency
For adults with pancreatic insufficiency, the recommended initial dosage of pancreipase is 500 lipase units/kg per meal (approximately 40,000 units for an 80 kg patient) and 250 lipase units/kg (approximately 20,000 units for an 80 kg patient) per snack, with titration based on clinical response. 1
Initial Dosing Recommendations
- For adults and children ≥4 years: Start with 500 lipase units/kg/meal 2
- For children >12 months to <4 years: Start with 1,000 lipase units/kg/meal 2
- For infants (birth to 12 months): 3,000 lipase units per 120 mL of formula or per breastfeeding 2
- For snacks: Administer approximately half the prescribed meal dose 2
Dosage Adjustments and Maximum Limits
- Titrate dosage upward as needed to reduce steatorrhea or gastrointestinal symptoms of maldigestion 1
- Maximum recommended dose: 2,500 lipase units/kg/meal or 10,000 lipase units/kg/day 1, 2
- Some patients may require higher doses (up to 80,000 units of lipase per meal) if documented effective by fecal fat measures or improvement in malabsorption symptoms 3
Administration Guidelines
- PERT should be taken during meals, not before or after, to maximize mixing with food and digestion of nutrients 1
- Capsules should be swallowed whole when possible 2
- For patients unable to swallow intact capsules, contents may be sprinkled on soft acidic foods (e.g., applesauce) 2
- Never crush or chew capsules or their contents 2
- Ensure adequate fluid intake to facilitate complete swallowing 2
Available Formulations
Pancreipase is available in several FDA-approved formulations with varying lipase strengths 1:
- Creon: Enteric-coated microspheres (3,000-36,000 lipase units)
- Zenpep: Enteric-coated beads (3,000-40,000 lipase units)
- Pancreaze: Enteric-coated microtablets (2,600-37,000 lipase units)
- Pertzye: Enteric-coated microspheres (4,000-24,000 lipase units)
- Viokace: Non-enteric-coated tablets (10,444-20,880 lipase units)
- Relizorb: In-line lipase cartridge for enteral feeding formulas 1
Special Considerations
- Non-enteric-coated preparations (Viokace) require co-administration with acid-reducing agents to prevent enzyme denaturation 1
- Enteric-coated preparations generally don't require acid suppression, though adding a proton pump inhibitor may improve efficacy in non-responders 1
- Over-the-counter pancreatic enzyme supplements should not be used as they are unregulated and of uncertain efficacy and safety 1
- For patients who fail to respond to standard therapy, consider: 1
- Checking compliance
- Reassessing diagnosis
- Increasing enzyme dose
- Adding acid suppression therapy
- Evaluating for other conditions (celiac disease, bacterial overgrowth, etc.)
Monitoring Effectiveness
- Assess clinical response through: 1
- Reduction in steatorrhea and gastrointestinal symptoms
- Weight gain or stabilization
- Improvement in fat-soluble vitamin levels
- Improvement in quality of life
- For patients with inadequate response, consider fecal fat testing or other pancreatic function tests 1
- Monitor nutritional status regularly, including fat-soluble vitamin levels 1
- Obtain baseline and periodic (every 1-2 years) dual-energy x-ray absorptiometry scans to assess bone health 1
Common Pitfalls to Avoid
- Underdosing is common and leads to persistent symptoms and malnutrition 4, 5
- Inappropriate timing of administration (before or after meals instead of during) reduces efficacy 1
- Restricting dietary fat is not recommended and may worsen malnutrition 3
- Failure to consider other causes of malabsorption in non-responders 1
- Not adjusting dosage based on meal size and fat content 1