Pancreatic Enzyme Pharmacotherapy

Abstract

Supplemental pancreatic enzyme preparations are provided to patients with conditions of pancreatic exocrine deficiency such as chronic pancreatitis and cystic fibrosis. These patients frequently experience steatorrhea, which occurs from inadequate fat absorption. The delivery of sufficient enzyme concentrations into the duodenal lumen simultaneously with meals can reduce nutrient malabsorption, improve the symptoms of steatorrhea, and in some cases alleviate the pain associated with chronic pancreatitis. Current clinical practices dictate administration of lipase 25,000-40,000 units/meal by using pH-sensitive pancrelipase microspheres, along with dosage increases, compliance checks, and differential diagnosis in cases of treatment failure. Despite the large number of specialty enzyme replacements available commercially, many patients remain dissatisfied with standard therapy, and future developments are needed to optimize treatment in these individuals.

Pleuropancreatic Fistulae: Specialist Center Management

“…Synthetic pancreatic supplements may offset this and should be administered from an early stage to enhance gut absorptive capacity. 1,[18][19][20][21][22][23][24][25] Most authors recommend using somatostatin analogues (Octretoide) although there is no direct evidence to suggest that octreotide helps a fistula to close that would not have otherwise done so. It may, however, expedite closure and at least limits protein and electrolyte losses during fistula management.…”

Delayed release pancrelipase for treatment of pancreatic exocrine insufficiency associated with chronic pancreatitis

“…PES are defined as pregnancy category B drugs, as there is inconclusive evidence for its use in lactation. 123 …”

Use of a Mutilumen Catheter to Assess the Bioavailability of an Enteric- Coated High-Buffered Pancrelipase Formulation in Patients with Exocrine Pancreatic Insufficiency

“…In adults with EPI secondary to acute/chronic pancreatitis or pancreatic cancer, this leads to steatorrhea and weight-loss. In children with EPI secondary to cystic fibrosis or Shwachman-Diamond Syndrome, this condition can also result in malabsorption with subsequent growth and developmentrelated disorders [1].…”

“…In adults with EPI secondary to acute/chronic pancreatitis or pancreatic cancer, this leads to steatorrhea and weight-loss. In children with EPI secondary to cystic fibrosis or Shwachman-Diamond Syndrome, this condition can also result in malabsorption with subsequent growth and developmentrelated disorders [1].Since most PEPs are specially formulated from porcine pancreas, considerable differences in enzyme activity are to be expected from different manufacturers and from batch to batch. The development of fibrosing colonopathy has been linked to administration of high potency (>20,000 USP units of lipase/capsule) and high dose pancreatic enzyme replacement therapy over time [2,3].…”