PERT is a prescription medication that replaces the digestive enzymes that the pancreas no longer makes in people with EPI. Its main component is pancrelipase, a mixture of lipase, protease, and amylase. These digestive enzymes help digest fat, protein and carbohydrates, respectively, and they support normal digestion and allow the body to absorb nutrients.
The U.S. Food and Drug Administration (FDA) has approved five pancrelipase products:
- Creon
- Zenpep
- Pancreaze
- Viokace
- Pertzye
The FDA withdrew approval for another PERT medication, Ultresa, in 2019.
People with EPI need to take PERT with every snack or meal to digest properly and resolve symptoms, and they typically need to take the medication for the rest of their lives.
An exception to this is children with a condition called Schwachman-Diamond syndrome, which can cause EPI. Around half of children with this condition start to produce the necessary hormones as they grow, so they may not need to continue taking PERT.
Manufacturers make PERT products from pig pancreas extracts. If this conflicts with your religious or ethical beliefs, talk to your healthcare provider about alternatives.
Dosage and Directions
PERT is available as a capsule, usually in two sizes: 10,000 units (mainly for children) and 25,000 units. Most adults need to take 25,000 to 40,000 units. Your healthcare team, including a physician, gastroenterologist, and dietitian, will recommend a dosage, starting at the low end and then gradually increasing to a maximum of 75,000 to 90,000 units until symptoms improve.
People typically take one capsule with the first mouthful of any meal. If you’re having a longer meal, take half the capsule when starting and one right after you finish. The American Gastrointestinal Association (AGA) recommends taking PERT with a cold beverage and never taking it on an empty stomach.
The side effects of PERT may include an upset stomach or constipation. If you experience these, let your doctor know. They may be able to adjust the dosage or prescribe a different product. Side effects often get better over time.
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