Pancreas
Examples
Pancreatin (Creon)
Indications
For any patient who does not have enough pancreatic enzyme reaching their duodenum. This may be due to cystic fibrosis, chronic pancreatitis, pancreatic surgery or as a result of an obstructed pancreatic duct.
Contraindications
Some stronger preparations such as Nutrizym 22 and Pancrease HL should be avoided in children with cystic fibrosis due to the risk of fibrosing colonopathy
Mechanism
Pancreatin is an extract of pancreatic enzymes (lipase, amylase and trypsin). It replaces or supplements pancreatic enzymes.
Administration
Oral
Adverse Reactions
- Higher doses can cause abdominal pain, nausea and vomiting
- Pancreatin can irritate the buccal mucosa if it is held in the mouth
- It can also cause hypersensitivity after a period of time in those individuals handling it
Interactions
Nil relevant.
Education
The pancreatic enzymes are extracted from pigs, this may not be compatible with some patients beliefs.
As these enzymes are inactivated by gastric acid they are either given in enteric coated preparations or given with a PPI or an H2-receptor antagonist e.g. Omeprazole, Ranitidine. This is usually given an hour before the dose is taken. Increased enzyme will reach the small bowel if the drug is taken immediately before or after food.
The dose is titrated to the patient's response to minimise malabsorption. This is done by looking at their stool form and frequency.
Pharmacokinetics
Nil relevant.
