Pancreatin (Pancreatic Enzyme Replacement Therapy — PERT)

How it works

It supplies the digestive enzymes lipase, amylase and protease, replacing deficient pancreatic secretions to aid the breakdown and absorption of fat, carbohydrate and protein.

Prescribing in practice

• Very high doses of high-strength preparations have been linked to fibrosing colonopathy, particularly in children with cystic fibrosis, so the total enzyme intake should be kept within recommended limits.
• Capsules and their granules should be taken with meals and snacks and not chewed, so the enzymes are released in the small bowel.
• Ensure adequate hydration, as inadequate fluid intake may contribute to bowel complications.

Monitoring

Monitor nutritional status, growth in children and control of steatorrhoea, adjusting the dose to symptoms and dietary fat intake.

Counselling the patient

• Advise patients to take the enzymes with every meal and snack and to swallow capsules whole, or sprinkle the granules onto soft acidic food without chewing.
• Explain that the dose may need adjusting with the fat content of meals and to report persistent diarrhoea or abdominal pain.

Evidence & guidelines

Pancreatic enzyme replacement therapy is the standard of care for exocrine pancreatic insufficiency, supported by NICE guidance on cystic fibrosis and pancreatitis.