Dosing Pancreatic Enzymes

Correct dosing of pancreatic enzymes is a big challenge for patients who suffer from EPI. We’ve heard from patients that once they receive they are told they have EPI, they are not guided or walked through what this means for them going forward. When are they supposed to take their pills? How do they know if they’re on the right dose?

In light of this, we’ve put together a video with Dr. Steven Freedman, a leading expert in pancreas disease and cystic fibrosis. This short, 5-minute guide will answer all the aforementioned questions and more. We hope that, after watching this video, patients walk away with a better understanding of exocrine pancreatic insufficiency and pancreatic enzyme replacement therapy (PERT). We’ve also included a summary of the video so you can follow along as Dr. Freedman discusses the dosing of pancreatic enzymes.

The Problem: No Consensus on Dosing Pancreatic Enzymes

Much confusion exists by patients as well as physicians on how to dose pancreatic enzymes. This is due to multiple factors:

1. Many different doses available for each pancreatic enzyme brand
2. Lack of understanding whether to dose based on a patient’s weight as per the FDA approval of each enzyme
3. How the size of a meal and types of food consumed such as fat should impact dosing
4. Degree of EPI

What Dose Should You Be On?

To answer this question, there are two questions that you must consider first.

(1) Do I have mild, moderate, or severe EPI? This is based on time length of disease, pancreatitis vs CF, history of pancreatic surgery, fecal elastase, symptoms including oily diarrhea and weight loss

(2) Size of the meal and amount of fat: Low fat vs high fat high calorie diets

Once you’ve considered the degree of EPI and size of the meal and fat content, you can group yourself into one of three categories:

• 2-3 25,000 lipase unit capsules (mild)
• 4-6 25,000 lipase unit capsules (moderate)
• 7-9 25,000 lipase unit capsules (severe)

Timing of Doses

Consider the following:

• How long it takes to eat a meal
  • Within 20 min (all with the 1^st bite)
  • 20-40 min (1/2 at the beginning, ½ at the end)
  • More than 40 min (1/3 beginning, 1/3 middle, 1/3 at the end)
• Issues with stomach (gastric) emptying

Dosing Pancreatic Enzymes Correctly

How do you know if you are still on the right dose? The following symptoms might indicate that you are not on the correct enzyme dose:

1. 1. Oily diarrhea (sticks to the toilet bowl)
   2. Continued weight loss
   3. Other GI symptoms although these can be non-specific
      • Bloating and gas
      • Abdominal pain and distention