Pancreatin is a standardized, porcine-derived pancreatic enzyme preparation containing a mixture of lipase, protease, and amylase. The 40000PFU strength refers to its lipase activity of 40,000 Ph. Eur. Units (equivalent to 40,000 USP Units). It is an essential enzyme replacement therapy used to correct exocrine pancreatic insufficiency (EPI) by aiding the digestion of fats, proteins, and carbohydrates in the duodenum. It is formulated as gastro-resistant (enteric-coated) microspheres or microtablets to protect the enzymes from gastric acid inactivation.
Adult: Highly individualized. Initial dose often ranges from 25,000 to 40,000 Ph. Eur. Units of lipase per main meal, and half that amount per snack. The dose is titrated based on symptoms (stool frequency, consistency) and nutritional parameters. Typical maintenance dose for severe EPI: 40,000-80,000 U lipase/meal.
Note: Take with each meal or snack. Swallow capsules whole with a glass of water; DO NOT crush or chew. For patients unable to swallow capsules (e.g., children), the contents can be mixed with a small amount of soft, acidic food (e.g., apple sauce, yogurt, fruit puree) at room temperature and swallowed immediately without chewing. Do not mix with alkaline foods or hot foods. Take while sitting upright.
Pancreatin compensates for deficient exocrine pancreatic secretion. The enteric-coated formulation protects the enzymes from denaturation by gastric acid. The coating dissolves at a pH > 5.5 (typically in the duodenum), releasing active enzymes. Lipase hydrolyzes triglycerides into monoglycerides and free fatty acids. Proteases (trypsin, chymotrypsin) break down proteins into peptides and amino acids. Amylase hydrolyzes starch into dextrins and sugars.
Pregnancy: Category C (US FDA). Animal reproduction studies have not been conducted. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Required for managing EPI in conditions like cystic fibrosis.
Driving: No effect. Dizziness has been reported rarely.
| Antacids (containing Calcium Carbonate or Magnesium Hydroxide) | May raise gastric pH prematurely, dissolving the enteric coating in the stomach and inactivating enzymes. | Moderate |
| H2-Receptor Antagonists (e.g., Famotidine) / Proton Pump Inhibitors (e.g., Omeprazole) | May be co-prescribed to ensure a higher duodenal pH for optimal enzyme release, especially in patients with low duodenal pH. This is often a beneficial interaction in EPI management. | Beneficial/Moderate |
| Acarbose / Miglitol | Theoretical interaction as both affect carbohydrate digestion. Clinical significance is unclear. | Mild |
| Orlistat | Both inhibit fat absorption via different mechanisms. Concomitant use is not recommended. | Major |