Is a 170mg Pancreatin Tablet the Same as PERT?
No, a tablet containing 170mg of pancreatin is not the same as prescription PERT and should not be used for treating exocrine pancreatic insufficiency. Over-the-counter pancreatic enzyme supplements are classified as dietary supplements only, with neither standardized dosing nor regulated efficacy, making their utility and safety unknown 1.
Why Over-the-Counter Pancreatin is Inadequate
Prescription PERT products are labeled based on their USP lipase content (typically ranging from 3,000 to 40,000 USP units per capsule), not by weight of pancreatin powder 1. The 170mg weight designation tells you nothing about the actual enzymatic activity, which is what matters clinically.
Key Differences Between OTC Pancreatin and Prescription PERT:
- Lack of standardization: Over-the-counter enzyme preparations have no standardized or regulated dosing, making them ineffective for treating pancreatic insufficiency 1, 2
- Unknown potency: The enzymatic activity (lipase, protease, amylase units) in OTC products is neither verified nor consistent between batches 1
- No enteric coating: Most OTC preparations lack the pH-sensitive enteric coating that protects enzymes from gastric acid degradation and ensures release in the duodenum 3, 4
- Inadequate dosing: Even if the 170mg contained some enzymatic activity, it would fall far short of the minimum recommended dose of 40,000 USP units of lipase per meal 1, 3
What Constitutes Proper PERT
All commercially available FDA-approved PERT products are of porcine origin and contain enteric-coated microspheres, beads, or microtablets 1, 3. These formulations include:
- Creon (enteric-coated microspheres) 3
- Zenpep (enteric-coated beads) 3
- Pancreaze (enteric-coated microtablets) 3
- Pertzye (enteric-coated microspheres) 3
Minimum Dosing Requirements:
- Adults require at least 40,000 USP units of lipase per main meal 1, 3, 2
- Adults require 20,000 USP units of lipase per snack (half the meal dose) 1, 3, 2
- For chronic pancreatitis specifically, doses range from 20,000-50,000 PhU of lipase per main meal 1, 3
Clinical Consequences of Using Inadequate Preparations
Failure to provide proper PERT in adequate doses results in continuation of maldigestion symptoms, micro- or macro-nutritional deficiencies, poor quality of life, and increased mortality 1. The adverse sequelae include:
- Persistent steatorrhea and gastrointestinal symptoms 1, 3
- Fat-soluble vitamin deficiencies (A, D, E, K) 1, 3
- Unintentional weight loss and protein malnutrition 1, 2
- Reduced quality of life and survival, particularly in pancreatic cancer patients 1
- Increased risk of osteoporosis from vitamin D and K deficiency 5
Common Pitfall to Avoid
Verify that patients are not using over-the-counter enzyme supplements instead of or in addition to prescription PERT, as this is a recognized cause of treatment failure 5. Research shows that even in insured US populations, only 30.4% of chronic pancreatitis patients and 21.9% of pancreatic cancer patients fill prescriptions for PERT, with even fewer receiving adequate doses 6.
Bottom Line
A 170mg pancreatin tablet is fundamentally different from prescription PERT in formulation, standardization, enzymatic potency, and clinical efficacy 1, 2. Patients with exocrine pancreatic insufficiency require FDA-approved, enteric-coated PERT products dosed based on USP lipase units, not milligrams of pancreatin powder.