Pancreatic Enzyme Replacement Therapy (PERT) helps those with Pancreatic Insufficiency (PI) digest the food they eat. For a more thorough and detailed explanation of use, dosing, generic enzymes, foods that don’t need enzymes, and signs of malabsorption, see: https://www.cff.org/PDF-Archive/Pancreatic-Enzyme-Replacement.pdf
There are many different brands and doses of enzymes. Dosing largely depends on symptoms and weight. Sometimes, patients can change the strength of their enzyme while still keeping the same dose. For example, if someone is taking 4 Creon 12 with each meal, they could change to taking 2 Creon 24 with each meal for a decreased pill burden. However, sometimes patients choose to take more capsules per meal of a lower strength due to capsule size (e.g. they are okay taking 8 Creon 6 with each meal because they cannot swallow large pills).
Dosing can also be based on grams of fat with each meal or snack. This method is a more exact method of dosing which can result in improved GI symptoms. It does involve math, however, to figure out the correct dosing. It also requires that the food either have a nutrition label with known grams of fat per serving or the use of websites like calorieking.com or myfitnesspal.com.
Argument for dosing based on grams of fat vs “this many” per meal and “this many” per snack:
- A patient with unresolved, daily abdominal pain and loose stools despite never missing enzymes with any meals or snacks. This patient has a medium chocolate milkshake for a snack (~40g fat), and then later has a dinner of teriyaki chicken, rice and steamed veggies (~8g fat without oil or butter on veggies).
- The snack would need a much higher dose of enzymes than the meal due to the higher fat content. But if the patient takes a “snack” dose with the milkshake, it will likely cause malabsorption, loose stools and abdominal pain.
- An example of fat based dosing looks like this: If the patient is on Zenpep 20, they would take one enzyme for every 10g fat. The milkshake would need 4 enzymes, where the meal would need about one (maybe two if the veggies are loaded with oil or butter).
- Talk with your Dietitian for more information on this topic and to receive an individualized dosing chart.
Dosing with tube feeds:
- Individualized based on amount of formula and length of tube feed.
- Typical dosing for an overnight feed is a split dose, one dose at the beginning of feed and one at the end
- This is not ideal because the enzymes do not last long enough to touch the middle of the overnight feed
- There is a new device, RELiZORB, which is hooked up in line with your tube feeding and will digest the fat in the formula on the way to the patient. For more information, contact your dietitian or visit http://relizorb.com/patient/meet-relizorb