Pancreatin

• pancreatin is used for pancreatic enzyme replacement therapy - it contains varying amounts of protease (trypsin, chymotrypsin, elasase), lipase and amylase, which help with the digestion of protein, fat and starch respectively
  
  
• pancreatin is used in conditions such as cystic fibrosis, and following pancreatectomy, total gastrectomy and chronic pancreatitis
  
  
• compared to trypsin and amylase, pancreatic lipase is more susceptible to acid denaturation - therefore it is easier to treat protein malabsorption with standard pancreatin supplements than fat malabsorption (steatorrhoea); gastric acid secretion may be reduced via adjuvant therapy with H2-antagonists or proton pump inhibitors
  
  
• there is evidence that pancreatin relieves pain in chronic pancreatitis
  
  
• side effects of pancreatin include:
  • abdominal discomfort
  • nausea and vomiting
  • diarrhoea or constipation
  • hypersensitivity to pancreatin supplement
  • buccal and perioral irritation if pancreatin retained in the mouth
  • excessive doses can cause perianal irritation
  • hyperuricosuria and hyperuricaemia have been associated with the use of very high doses of pancreatin
  • fibrosing colonopathy

Check SPC before prescribing pancreatin.

Reference

1. de la Iglesia-García D et al. NIHR Pancreas Biomedical Research Unit Patient Advisory Group. Efficacy of pancreatic enzyme replacement therapy in chronic pancreatitis: systematic review and meta-analysis. Gut. 2017 Aug;66(8):1354-1355.