Pancreatic enzyme supplements

This page was reviewed under our medical and editorial policy by

Gagandeep Singh, MD, Liver and Pancreatic Surgeon, City of Hope | Duarte

This page was reviewed on June 9, 2023.

Patients with certain diseases of the pancreas, such as pancreatic cancer, may face nutritional issues due to problems with food digestion. This may lead the care team to prescribe pancreatic enzyme supplements as part of the patient’s care plan.

What are pancreatic enzymes?

When functioning normally, the pancreas produces the digestive enzymes needed to break down food. These enzymes include amylase, trypsin and lipase. But when a person’s pancreas isn’t producing or releasing enough of these enzymes for digestion—a condition called pancreatic enzyme insufficiency—the patient needs to get them from pancreatic enzyme replacement therapy (PERT). This treatment involves taking pancreatic enzyme supplements orally, every time the person eats or drinks.

Pancreatic enzyme supplements replace the missing enzymes that the pancreas would normally produce so the patient can digest fat, carbohydrates and protein.

Who takes digestive enzyme supplements?

It's common for people with pancreatic cancer to take pancreatic enzyme supplements. This type of cancer damages the pancreas and can block the flow of enzymes to the intestine, interfering with digestion. Similarly, if some or all of the patient's pancreas has been removed as part of pancreatic cancer treatment, the body's ability to digest food may be impaired. Certain tumors may also cause high levels of stomach acid, making pancreatic enzymes less impactful.

The patient also may need PERT if he or she has another type of cancer that causes inflammation of the pancreas (pancreatitis) or cystic fibrosis, an inherited disorder that produces thick mucus, which may block the pancreatic ducts. Both conditions may lead to nutritional deficiencies and cause:

  • Gas and bloating
  • Loose stool with a bad odor
  • Stool that floats
  • Abdominal cramping and pain
  • Unexplained weight loss

Types of pancreatic enzyme supplements

Pancreatic enzyme supplements are tablets or capsules containing a combination of lipase, amylase and protease. They are sometimes also called pancreatin or pancrelipase.

The U.S. Food and Drug Administration has approved the following six pancreatic enzyme supplements:

  • Creon®
  • Zenpep®
  • Pancreaze®
  • Ultresa®
  • Pertzye®
  • Viokace®

Most pancreatic enzymes have a special coating (enteric coating) so that stomach acid doesn't break down the medication before it reaches the small intestine, where it’s needed. However, Viokace® doesn’t have an enteric coating and must be taken along with a proton pump inhibitor to lower stomach acid levels.

How and when to take digestive enzymes

It's important to take enough enzymes to break down and digest food. Most adults take two to four 25,000-unit tablets or capsules with each meal or snack. The patient may be started on a low dose at first, but the care team may gradually increase it until the patient reaches the appropriate dose. It can take a week or two to adjust to a new dose.

Take the enzymes at the beginning of every meal or snack, including milk-based shakes and other nutritional supplements. Swallow the tablets or capsules whole, and don't take them with hot beverages because this can damage the enzymes and make them less functional.

For meals that last longer than 30 minutes or have multiple courses, the patient may need to take additional enzymes.

Tips for taking pancreatic enzyme supplements

When taking pancreatic enzyme supplements, keep in mind the following tips:

  • Never take enzymes on an empty stomach.
  • Don’t take pancreatic enzyme supplements with a hot drink or while drinking clear liquids without food.
  • Don’t chew or crush pancreatic enzyme supplements—swallow them whole.
  • Don’t take enzymes if only a very small portion of food is consumed, like a small quantity of fruits and vegetables or a single piece of candy.
  • Follow the doctor's instructions for increasing the dose whenever the patient eats a large or high-fat meal.
  • Take pancreatic enzyme supplements with every meal or snack. Otherwise, symptoms may return or worsen.
  • Keep a log of what the patient ate, the enzyme dose he or she took, and whether it helped with symptoms. This can be helpful information for determining what works best.

Digestive enzyme side effects

Common potential side effects of pancreatic enzyme supplements may include:

  • Stomach pain
  • Nausea or vomiting
  • Diarrhea
  • Constipation
  • Cramps
  • Gas or bloating
  • Headache

It may be unsafe to take prescription pancreatic enzyme products in higher doses than prescribed. High doses of enzymes may worsen side effects and increase the risk of a rare bowel disorder.

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