PANCREATIC ENZYMES

What are pancreatic enzymes?

Pancreatic enzymes are natural chemicals that help break down fats, proteins and carbohydrates. A normally functioning pancreas secretes about 8 cups of fluid, called pancreatic juice, daily into the duodenum, the portion of the small intestine that connects with the stomach. This fluid contains pancreatic enzymes and helps neutralize stomach acid as it enters the small intestine.

Types of Pancreatic Enzymes and Their Effects 

Reasons to Take Pancreatic Enzymes

Pancreatic insufficiency is the inability of the pancreas to secrete the enzymes needed for digestion. Having an insufficient amount of pancreatic enzymes is very common among people with pancreatic cancer. When the pancreas does not produce enough enzymes to break down food, pancreatic enzyme products are needed. Doctors sometimes prescribe digestive enzymes, including pancreatic enzymes, to patients who have conditions that cause poor absorption. These products help improve digestion and absorption of food.

Some of the conditions that may cause pancreatic insufficiency are:

• Whipple procedure
• total pancreatectomy (complete removal of the pancreas)
• blockage or narrowing of the pancreatic or biliary duct (the tubes that carry pancreatic juice or bile)
• pancreatic or duodenal tumors
• cystic fibrosis
• pancreatitis

Pancreatic insufficiency may cause feelings of indigestion, cramping after meals, large amounts of gas, foul smelling gas or stools, floating or greasy/fatty stools, frequent stools, loose stools and weight loss. Patients with these symptoms should consider taking pancreatic enzyme products.

About 25% of patients who have the Whipple procedure will have malabsorption. The Whipple procedure is the most commonly used operation for removing a pancreatic tumor. Patients who have radiation therapy along with the Whipple procedure are much more likely to have malabsorption.

Sources of Supplemental Pancreatic Enzymes
Pancreatic enzyme products are available in both prescription and non-prescription forms. The different brands of pancreatic enzyme products are not identical. The United States Food and Drug Administration (FDA) has mandated that all prescription pancreatic enzyme products obtain FDA approval to ensure effectiveness, safety and manufacturing consistency. In order to gain FDA approval, companies have to prove that their pancreatic enzyme product is effective, safe and manufactured consistently from one batch to the next.

Over-the-counter pancreatic enzyme supplements are available without a prescription. Since they are classified as dietary supplements rather than drugs, the FDA regulates them under a different set of regulations. While manufacturers of over-the-counter supplements are required to ensure the safety of their products, there are no controls on manufacturing consistency from one batch to the next. Therefore, these products are not recommended for use in patients with pancreatic cancer.

The recommended type and dosage of pancreatic enzymes must be individualized for each person. Most people start by taking 8,000 – 12,000 lipase units with snacks and 16,000 – 36,000 lipase units with meals. Some individuals adapt to different doses of enzymes throughout their care. It is important to discuss with a doctor or dietitian the appropriate type and dose of pancreatic enzymes at regular visits.

Prescription Pancreatic Enzymes
All prescription enzymes come from a porcine (pig) source. If a person has allergies to porcine products, consult a doctor and/or dietitian for alternative options.

Approved by the United States FDA:

Creon® capsules
Pancreaze® capsules
Pertzye® capsules
Ultresa™ capsules
Viokace™ capsules
Zenpep® capsules

For more information about the FDA and pancreatic enzymes, visit the FDA website by clicking here or call a PALS Associate at the Pancreatic Cancer Action Network toll free at 877-272-6226 or email pals@pancan.org.

Taking Pancreatic Enzymes
The doctor may prescribe an acid-reducing medication to help improve the effectiveness of some pancreatic enzyme products. Acid reducing medications include proton pump inhibitors, such as esomeprazole (Nexium®) or omeprazole (Prilosec®), and H2 blockers, such as famotidine (Pepcid®), cimetidine (Tagamet®) and ranitidine (Zantac®).

Tips to obtain the best results from pancreatic enzymes:

• Take enzymes with every meal or snack that contains fat, especially meat, dairy, bread and desserts.
  
  
• Start with the smallest dose necessary. Adjust according to the severity of the pancreatic insufficiency. Further alterations may be needed from time to time.
  
  
• Take the enzymes at the beginning of the meal or snack. This is very important for proper enzyme functioning. When taking multiple enzymes, take some at the beginning of the meal and the rest at various points throughout the meal. Enzymes generally do not work well if forgotten and only taken at the end of the meal.
  
  
• Swallow intact tablets and capsules with liquid at mealtimes. Some enzyme products have a special coating to prevent breakdown in the stomach. The tablets should not be crushed or chewed unless directed by a member of your medical team.
  
  
• If held in the mouth for a length of time, certain pancreatic enzyme products may begin to digest the mucous membranes and cause irritation. This can lead to sores on the mouth, lips and tongue. If swallowing a capsule is difficult, open the capsule and add its contents to a spoonful of soft food that does not require chewing and can be swallowed immediately. Some recommended foods are applesauce, gelatin, pureed apricot, banana or sweet potatoes.
  
  
• To promote enzyme function, do not mix the contents of the capsules (microspheres) with milk, custard, ice cream or other dairy products before swallowing. These foods have a higher pH that may dissolve the microspheres’ coating and destroy enzyme activity before they reach the stomach.
  
  
• Pancreatic enzymes may have reduced effectiveness if taken at the same time as calcium- or magnesium-containing antacids, such as Maalox®, Mylanta®, Tums®, Rolaids® and others.
  
  
• Use enzymes prior to their expiration date. They may become less effective as they get older.

Side Effects of Pancreatic Enzymes
The most common side effect of pancreatic enzymes is constipation. Enzymes may also cause nausea, abdominal cramps or diarrhea, though these symptoms are less common.

Discontinue the use of pancreatic enzymes if any signs of hypersensitivity or allergic reaction appear. Pork is used in the preparation of prescription enzymes. Therefore, individuals with allergies to pork or pork products should work with their pharmacist, dietitian and doctor to find an appropriate enzyme preparation. Pancreatic enzymes may decrease the absorption of some iron salts. Tell the doctor and registered dietitian about all current medications and medical conditions while discussing the use of pancreatic enzymes.

If taken properly, pancreatic enzymes can help prevent weight loss and control symptoms associated with pancreatic enzyme insufficiency. Ask the doctor to prescribe the proper pancreatic enzymes.

The information and services provided by the Pancreatic Cancer Action Network, Inc. are for informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnosis or treatment. If you are ill, or suspect that you are ill, see a doctor immediately! The Pancreatic Cancer Action Network does not recommend nor endorse any specific physicians, products or treatments even though they may be mentioned on this site. In addition, please note that any personal information you provide to the Pancreatic Cancer Action Network's associates during telephone and/or email consultations may be stored in a secure database to assist the Pancreatic Cancer Action Network, Inc. in providing you with the best service possible. Portions of the constituent data stored in this database may be used to inform future programs and services of the Pancreatic Cancer Action Network, Inc., and may be provided in aggregate form to third parties to guide future pancreatic cancer research and treatment efforts. The Pancreatic Cancer Action Network, Inc. will not provide personal identifying information (such as your name or contact information) to third parties without your advanced written consent.  130124