Pancreatic enzyme supplements

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.

How do pancreatic enzyme supplements work?

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

Who takes pancreatic enzyme supplements?

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:

• 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 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:

• 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 pancreatic enzyme supplements

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.

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 when you’re drinking clear liquids without food.
• Don’t chew or crush pancreatic enzyme supplements—swallow them whole.
• Don’t take enzymes if you eat a very small portion of food, like a small quantity of fruits and vegetables or a single piece of candy.
• Follow your doctor's instructions for increasing your dose whenever you eat a large or high-fat meal.
• Take pancreatic enzyme supplements with every meal or snack. Otherwise, your symptoms may return or worsen.
• Keep a log of what you ate, the enzyme dose you took, and whether it helped with symptoms. This can be helpful information for determining what works best for you.

Possible 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.