Exocrine Pancreatic Insufficiency Medication

Updated: May 23, 2023
  • Author: Samer Al-Kaade, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Medication Summary

The goals of pharmacotherapy are to improve the digestion and absorption of nutrients, to reduce morbidity, and to prevent complications.


Pancreatic Enzyme Products

Class Summary

Pancreatic enzyme products (PEPs) are a combination of porcine-derived amylases, lipases and proteases and are used to treat exocrine pancreatic insufficiency (EPI). They mimic digestive enzymes secreted by the pancreas and act in the duodenum and proximal small intestine. They catalyze the hydrolysis of starches into dextrins and short-chain sugars such as maltose and maltriose; fats into monoglycerides, glycerol, and free fatty acids; and proteins into peptides and amino acids.

Creon, Pancreaze, Pertzye, Ultresa, Viokace, Zenpep are the only PEPs that have been approved by the US Food and Drug Administration (FDA) for marketing in the United States. [47, 48]

Pancrelipase (Creon, Pancreaze, Pertzye, Ultresa, Viokace, Zenpep)

With the exception of Viokace, all PEPs have enteric coatings and are used to treat EPI due to cystic fibrosis or other conditions. Viokace is used in combination with a proton pump inhibitor to treat pancreatic insufficiency due to chronic pancreatitis or pancreatectomy.

The PEPs are not interchangeable. When a patient is switched to a new PEP, the dose must be started at a similar amount of lipase units and then titrated according to patient response. It may take 1-2 weeks for the patient to adjust to new PEP dose, which can vary.