Pancreatin is a porcine-derived pancreatic enzyme preparation containing a standardized mixture of digestive enzymes: lipase, protease, and amylase. It is an essential pancreatic enzyme replacement therapy (PERT) used to compensate for exocrine pancreatic insufficiency (EPI). In the Indian context, it is a critical drug for managing maldigestion and malabsorption syndromes, particularly in chronic pancreatitis, which has a high prevalence in certain regions.
Adult: Highly individualized based on fat intake and clinical response. General guideline: 25,000-80,000 Ph. Eur. units of lipase per main meal and half that amount per snack. A 300mg capsule (approx. 10,000 lipase units) may equate to 2-8 capsules per meal. Start low and titrate upwards. Maximum dose should not exceed 10,000 lipase units/kg/meal unless under specialist supervision.
Note: MUST be taken WITH meals or snacks. Swallow enteric-coated capsules whole; do not crush or chew. For patients unable to swallow capsules (e.g., children, elderly), the enteric-coated granules can be mixed with a small amount of soft, acidic food (pH <5.0 like applesauce, yogurt) at room temperature and swallowed immediately without chewing. Follow with a glass of water. Concomitant administration of a proton pump inhibitor (e.g., Omeprazole) may be needed if gastric pH is too low for enteric coating to remain intact.
Pancreatin supplements deficient endogenous pancreatic enzymes in the duodenum and proximal jejunum. It contains lipase, which hydrolyzes triglycerides into monoglycerides and free fatty acids; amylase, which hydrolyzes starch into dextrins and sugars; and protease (trypsin, chymotrypsin), which hydrolyzes proteins into peptides and amino acids. This action facilitates the normal digestion of fats, proteins, and carbohydrates, correcting steatorrhea, azotorrhea, and creatorrhea associated with Exocrine Pancreatic Insufficiency (EPI).
Pregnancy: Category C (US FDA). Animal reproduction studies have not been conducted. Use only if clearly needed. Pancreatin is not absorbed systemically, so direct fetal risk is low. However, untreated EPI poses significant nutritional risks to mother and fetus. Benefit generally outweighs risk.
Driving: No effect. The drug does not affect the central nervous system.
| Acarbose / Miglitol | Pancreatin may reduce the efficacy of these alpha-glucosidase inhibitors by digesting complex carbohydrates, potentially leading to hyperglycemia. | Moderate |
| Orlistat | Additive effect on fat malabsorption, leading to severe steatorrhea and potential fat-soluble vitamin deficiencies. Concurrent use is contraindicated. | Major |
| Antacids (Calcium/Magnesium Carbonate) | May raise gastric pH prematurely, causing dissolution of the enteric coating in the stomach and inactivation of enzymes by gastric acid. | Moderate |
| Iron Supplements (Ferrous Sulphate) | Pancreatin may impair iron absorption, potentially worsening anemia. Administer iron supplements at a different time (e.g., between meals). | Moderate |
| Folic Acid | Pancreatin may impair folate absorption. Monitor levels in long-term use. | Moderate |
Same composition (Pancreatin (300mg)), different brands: