1. Clinical Overview
Pancreatin is a porcine-derived pancreatic enzyme concentrate standardized to contain lipase, amylase, and protease activities. The 220mg strength typically provides approximately 8,000 USP units of lipase, 30,000 USP units of amylase, and 35,000 USP units of protease. It acts as a digestive aid, replacing deficient exocrine pancreatic secretions in the duodenum to facilitate the digestion of fats, proteins, and carbohydrates.
| Onset | Duration | Bioavailability |
|---|---|---|
| Within 30-60 minutes of oral administration. | Approximately 4-6 hours, corresponding to the digestive phase of a meal. | Not applicable in the conventional sense. Enzymes are not absorbed systemically; they act locally in the gastrointestinal lumen. |
2. Mechanism of Action
Pancreatin contains a mixture of digestive enzymes (lipase, amylase, protease) derived from porcine pancreas. It acts as a physiological replacement for deficient endogenous pancreatic secretions. Lipase hydrolyzes 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 occurs in the duodenum and proximal jejunum, facilitating normal digestion and absorption of nutrients.
3. Indications & Uses
- Exocrine Pancreatic Insufficiency (EPI) due to chronic pancreatitis
- Exocrine Pancreatic Insufficiency due to cystic fibrosis
- Exocrine Pancreatic Insufficiency following pancreatectomy or gastrectomy
4. Dosage & Administration
Adult Dosage: Individualized based on fat intake and clinical response. Typical starting dose: 1-2 capsules (220mg each) with each meal and 1 capsule with snacks. Dosage is titrated to control steatorrhea (usual range: 500 to 2,500 USP units of lipase per kg per meal).
Administration: Must be taken with meals or snacks. Swallow capsules whole with plenty of liquid (water). DO NOT crush or chew the capsules/tablets as this destroys the enteric coating. For patients unable to swallow capsules (e.g., infants, elderly), the capsule can be opened and the microspheres/mini-tablets mixed with a small amount of soft, acidic food (e.g., applesauce, yogurt, fruit puree) at room temperature and administered immediately. Do not mix with alkaline foods or hold in mouth.
5. Side Effects
Common side effects may include:
- Abdominal discomfort or pain
- Nausea
- Flatulence
- Diarrhea or constipation
6. Drug Interactions
| Drug | Effect | Severity |
|---|---|---|
| Acarbose / Miglitol | May reduce efficacy of these anti-diabetic drugs. Pancreatic enzymes digest complex carbohydrates that acarbose acts upon. | Moderate |
| Antacids (containing Calcium Carbonate or Magnesium Hydroxide) | May compromise the integrity of the enteric coating if taken simultaneously, leading to premature enzyme inactivation. | Moderate |
| H2 Receptor Antagonists (e.g., Ranitidine) / Proton Pump Inhibitors (e.g., Omeprazole) | May improve efficacy of pancreatin by reducing gastric acidity, protecting enzymes. Often co-prescribed. | Beneficial |
| Iron supplements | Pancreatin may impair iron absorption. Administer at different times. | Moderate |
| Folic Acid | Pancreatin may impair folic acid absorption. Monitor levels. | Moderate |
7. Patient Counselling
- DO take the capsule with every meal or substantial snack.
- DO swallow the capsule whole with a full glass of water.
- DO NOT crush, chew, or hold the capsule or its contents in your mouth.
- DO NOT mix the contents with alkaline or hot foods (>40°C) if opening the capsule.
- If opening capsule, mix contents immediately with a small amount of soft, acidic food (e.g., applesauce) and consume entirely. Do not store the mixture.
- DO inform your doctor if you are allergic to pork.
8. Toxicology & Storage
Overdose: Very high doses, particularly in children with cystic fibrosis, are associated with fibrosing colonopathy (symptoms: abdominal pain, distension, vomiting, constipation, change in bowel habits). Hyperuricemia and gout may occur due to excessive purine intake.
Storage: Store below 25°C in a cool, dry place. Protect from moisture. Keep in the original container tightly closed. Do not refrigerate. Keep out of reach of children.