This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science.
This page was reviewed on September 12, 2022.
When functioning normally, your pancreas produces the digestive enzymes you need to break down the food you eat. These enzymes include amylase, trypsin and lipase. But when your pancreas isn’t producing or releasing enough of these enzymes for digestion—a condition called pancreatic enzyme insufficiency—you need to get them from pancreatic enzyme replacement therapy (PERT). This treatment involves taking pancreatic enzyme supplements orally, every time you eat or drink.
Pancreatic enzyme supplements replace the missing enzymes that your pancreas would normally produce so you can digest fat, carbohydrates and protein.
It's common to take pancreatic enzyme supplements if you have pancreatic cancer. 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 your pancreas has been removed as part of cancer treatment, your body's ability to digest food may be impaired. Certain tumors can also cause high levels of stomach acid, making pancreatic enzymes less impactful.
You also may need PERT if you have 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 can lead to nutritional deficiencies and cause the following symptoms:
Pancreatic enzyme supplements are tablets or capsules in 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:
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.
It's important to take enough enzymes to break down and digest your food, and most adults take two to four 25,000-unit tablets or capsules with each meal or snack. You may be started on a low dose at first, but your doctor may gradually increase it until you reach 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, you may need to take additional enzymes.
When taking pancreatic enzyme supplements, keep in mind the following tips:
Common potential side effects of pancreatic enzyme supplements may include:
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.