Pancreatic Enzyme Replacement Therapy

PANCREATIC ENZYME REPLACEMENT THERAPY
Pancreatic enzyme products (lipase/protease/amylase) are not interchangeable. Dosing should not exceed the recommended maximum dosage set forth by the Cystic Fibrosis Foundation Consensus Conferences Guidelines.
Brand	Strength	Form	Dose*
Creon	3000Units/9500Units/15000Units, 6000Units/19000Units/30000Units, 12000Units/38000Units/60000Units, 24000Units/76000Units/120000Units, 36000Units/114000Units/180000Units	del-rel caps	≤12mos: 3000 lipase units per 120mL of formula or per breastfeeding. >12mos–<4yrs: 1000 lipase units/kg per meal. ≥4yrs: 500 lipase units/kg per meal. Max (>12mos): 2500 lipase units/kg per meal (or ≤10000 lipase units/kg/day), or <4000 lipase units/g fat ingested per day. Adults with exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatectomy: Individualize.
Pancreaze	2600Units/6200Units/10850Units, 4200Units/14200Units/24600Units, 10500Units/35500Units/61500Units, 16800Units/56800Units/98400Units, 21000Units/54700Units/83900Units	caps	≤12mos: 2,600 lipase units per 120mL of formula or per breastfeeding. >12mos–<4yrs: Initially 1000 lipase units/kg per meal. ≥4yrs: Initially 500 lipase units/kg per meal. Max (>12mos): 2500 lipase units/kg per meal (or ≤10000 lipase units/kg/day), or <4000 lipase units/g fat ingested per day.
Pertzye	4000Units/14375Units/15125Units, 8000Units/28750Units/30250Units, 16000Units/57500Units/60500Units 24000Units/86250Units/90750Units	del-rel caps	≤12mos: 4,000 lipase units per 120mL of formula or per breastfeeding. >12mos–<4yrs: Initially 1000 lipase units/kg per meal. ≥4yrs: Initially 500 lipase units/kg per meal. Max (>12mos): 2500 lipase units/kg per meal (or ≤10000 lipase units/kg/day), or <4000 lipase units/g fat ingested per day.
Viokace^†	10440Units/39150Units/39150Units, 20880Units/78300Units/78300Units	tabs	Adults: Initially 500 lipase units/kg per meal. Max: 2500 lipase units/kg per meal (or ≤10000 lipase units/kg/day), or <4000 lipase units/g fat ingested per day. Children: Not established.
Zenpep	3000Units/10000Units/14000Units, 5000Units/17000Units/24000Units, 10000Units/32000Units/42000Units, 15000Units/47000Units/63000Units, 20000Units/63000Units/84000Units, 25000Units/79000Units/105000Units, 40000Units/126000Units/168000Units	del-rel caps	≤12mos: 3000 lipase units per 120mL of formula or per breastfeeding. >12mos–<4yrs: Initially 1000 lipase units/kg per meal. ≥4yrs: Initially 500 lipase units/kg per meal. Max (>12mos): 2500 lipase units/kg per meal (or ≤10000 lipase units/kg/day), or <4000 lipase units/g fat ingested per day.
NOTES
Start at the lowest recommended dose and increase gradually. Individualize based on clinical symptoms, the degree of steatorrhea present, and the fat content of the diet. ^†Take in combination with a proton pump inhibitor. Administration:* Infants: Give immediately prior to each feeding, followed by breast milk or formula (do not mix directly). May mix contents with small amount of applesauce or other acidic soft food (pH≤4.5) or given directly into the mouth. Do not let any drug remain in mouth. Children and adults: Take with meals or snacks. Swallow whole. May open and sprinkle contents into small amount of applesauce or other acidic soft food (pH≤4.5); swallow mixture immediately, followed by water or juice. Do not let any drug remain in mouth. Not an inclusive list of medications and/or official indications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. (Rev. 4/2019)

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