Pancreatin is a porcine-derived pancreatic enzyme concentrate containing a mixture of digestive enzymes: lipase, amylase, and protease. It is a standardised preparation used as pancreatic enzyme replacement therapy (PERT) to compensate for exocrine pancreatic insufficiency (EPI). The 500mg strength typically provides approximately 8,000-12,000 USP units of lipase, 30,000-45,000 USP units of amylase, and 30,000-45,000 USP units of protease, though exact potency varies by manufacturer. It is a cornerstone therapy for managing maldigestion and malabsorption in chronic pancreatitis, cystic fibrosis, and post-pancreatectomy.
Adult: Highly individualized based on fat intake and clinical response. Initial dose often 500mg (1 capsule/tablet) with each main meal and 250mg (half) with snacks. Titration is based on reduction of steatorrhea and symptoms. Typical maintenance: 25,000-80,000 USP units of lipase per meal. The 500mg preparation provides approx. 8,000-12,000 USP lipase.
Note: CRITICAL: Take WITH meals or snacks, at the beginning or during the meal. Swallow whole; DO NOT crush, chew, or hold in mouth (can cause mucosal irritation). For patients unable to swallow capsules (e.g., children), the capsule can be opened and the enteric-coated microspheres/minitablets mixed with a small amount of soft, acidic food (e.g., applesauce, yogurt, fruit puree) at room temperature and taken immediately. Do not mix with alkaline foods or hot foods. Follow with a glass of water.
Pancreatin supplements deficient endogenous pancreatic enzymes in the duodenum and proximal jejunum. Lipase hydrolyzes dietary triglycerides into monoglycerides and free fatty acids. Amylase hydrolyzes starch into dextrins and sugars. Proteases (trypsin, chymotrypsin) hydrolyze proteins into peptides and amino acids. This enzymatic action facilitates normal digestion and absorption of fats, carbohydrates, and proteins.
Pregnancy: Category C (US FDA). Animal reproduction studies not conducted. Use only if clearly needed. Pancreatin is not absorbed systemically, so direct fetal risk is low. The benefit of treating maternal malnutrition outweighs potential risk.
Driving: No effect. Does not cause sedation.
| Antacids (Calcium/Magnesium Carbonate, Aluminum Hydroxide) | May raise gastric pH prematurely, dissolving enteric coating and inactivating enzymes. | Moderate |
| H2-Receptor Antagonists (Famotidine, Ranitidine) / Proton Pump Inhibitors (Omeprazole, Pantoprazole) | May improve efficacy by reducing gastric acid, protecting non-enteric coated enzymes. For enteric-coated products, effect is minimal but may be beneficial in patients with very low duodenal pH. | Mild |
| Acarbose / Miglitol | Theoretical antagonism; pancreatin aids carbohydrate digestion, while these drugs delay it. Clinical significance unclear. | Mild |
| Iron Supplements (Ferrous Sulfate) | Pancreatin may impair iron absorption. 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 |