digestive enzymes (Rx, OTC)

Brand and Other Names:Arco Lase, Digepepsin, more...Gustase
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

delayed release capsules

  • Pertzye (bicarbonate buffered enteric buffered microspheres): Lipase (8,000 units), protease (28,750 units), amylase (30,250 units)
  • Pertzye (bicarbonate buffered enteric buffered microspheres): Lipase (16,000 units), protease (57,500 units), amylase (60,500 units)
  • Pancrelipase (enteric coated beads): Lipase (5,000 units), protease (17,000 units), amylase (27,000 units)
  • Zerpep (enteric coated beads): Lipase (3,000 units), protease (10,000 units), amylase (16,000 units)
  • Zerpep (enteric coated beads):  Lipase (5,000 units), protease (17,000 units), amylase (27,000 units)
  • Zerpep (enteric coated beads):  Lipase (10,000 units), protease (34,000 units), amylase (55,000 units)
  • Zerpep (enteric coated beads):  Lipase (15,000 units), protease (51,000 units), amylase (82,000 units)
  • Zerpep (enteric coated beads):  Lipase (20,000 units), protease (68,000 units), amylase (109,000 units)
  • Zerpep (enteric coated beads):  Lipase (25,000 units), protease (85,000 units), amylase (136,000 units)
  • Creon (enteric coated microspheres): Lipase (3,000 units), protease (9,500 units), amylase (15,000 units)
  • Creon (enteric coated microspheres): Lipase (6,000 units), protease (19,000 units), amylase (30,000 units)
  • Creon (enteric coated microspheres): Lipase (12,000 units), protease (38,000 units), amylase (60,000 units)
  • Creon (enteric coated microspheres): Lipase (24,000 units), protease (76,000 units), amylase (120,000 units)

delayed release capsules, enteric coated microtablets

  • Pancreaze: Lipase (4,200 units), protease (10,000 units), amylase (17,500 units)
  • Pancreaze: Lipase (10,500 units), protease (25,000 units), amylase (43,750 units)
  • Pancreaze: Lipase (16,800 units), protease (40,000 units), amylase (70,000 units)
  • Pancreaze: Lipase (16,800 units), protease (40,000 units), amylase (70,000 units)
  • Pancreaze: Lipase (21,000 units), protease (37,000 units), amylase (61,000 units)
  • Ultresa: Lipase 13,800 units), protease (27,600 units), amylase (27,600 units)
  • Ultresa: Lipase 20,700 units), protease (41,400 units), amylase (41,400 units)
  • Ultresa: Lipase 23,000 units), protease (46,000 units), amylase (46,000 units)     

tablet

  • Viokace: Lipase 10,440 units), protease (39,150 units), amylase (39,150 units) 
  • Viokace: Lipase 20,880 units), protease (78,300 units), amylase (78,300 units) 
more...

Pancreatic Insufficiency

500 lipase units/kg per meal initially (up to the maximum dose); half the prescribed dose given for an individualized full meal often administered with each snack; total daily dose should reflect approximately 3 meals plus 2 or 3 snacks/day

Dose should not exceed 2,500 lipase units/kg per meal; 10,000 lipase units/kg/day; or 4,000 lipase units/g of fat ingested per day

Chronic Pancreatitis or Pancreatectomy

Creon: 72,000 lipase units per meal while consuming at least 100 g of fat per day

Dosage Forms & Strengths

delayed release capsules

  • Pertzye (bicarbonate buffered enteric buffered microspheres): Lipase (8,000 units), protease (28,750 units), amylase (30,250 units)
  • Pertzye (bicarbonate buffered enteric buffered microspheres): Lipase (16,000 units), protease (57,500 units), amylase (60,500 units)
  • Pancrelipase (enteric coated beads): Lipase (5,000 units), protease (17,000 units), amylase (27,000 units)
  • Zerpep (enteric coated beads):  Lipase (3,000 units), protease (10,000 units), amylase (16,000 units)
  • Zerpep (enteric coated beads):  Lipase (5,000 units), protease (17,000 units), amylase (27,000 units)
  • Zerpep (enteric coated beads):  Lipase (10,000 units), protease (34,000 units), amylase (55,000 units)
  • Zerpep (enteric coated beads):  Lipase (15,000 units), protease (51,000 units), amylase (82,000 units)
  • Zerpep (enteric coated beads):  Lipase (20,000 units), protease (68,000 units), amylase (109,000 units)
  • Zerpep (enteric coated beads):  Lipase (25,000 units), protease (85,000 units), amylase (136,000 units)
  • Creon (enteric coated microspheres): Lipase (3,000 units), protease (9,500 units), amylase (15,000 units)
  • Creon (enteric coated microspheres): Lipase (6,000 units), protease (19,000 units), amylase (30,000 units)
  • Creon (enteric coated microspheres): Lipase (12,000 units), protease (38,000 units), amylase (60,000 units)
  • Creon (enteric coated microspheres): Lipase (24,000 units), protease (76,000 units), amylase (120,000 units)

delayed release capsules, enteric coated microtablets

  • Pancreaze: Lipase (4,200 units), protease (10,000 units), amylase (17,500 units)
  • Pancreaze: Lipase (10,500 units), protease (25,000 units), amylase (43,750 units)
  • Pancreaze: Lipase (16,800 units), protease (40,000 units), amylase (70,000 units)
  • Pancreaze: Lipase (16,800 units), protease (40,000 units), amylase (70,000 units)
  • Pancreaze: Lipase (21,000 units), protease (37,000 units), amylase (61,000 units)
  • Ultresa: Lipase 13,800 units), protease (27,600 units), amylase (27,600 units)
  • Ultresa: Lipase 20,700 units), protease (41,400 units), amylase (41,400 units)
  • Ultresa: Lipase 23,000 units), protease (46,000 units), amylase (46,000 units)

tablet

  • Viokace: Lipase 10,440 units), protease (39,150 units), amylase (39,150 units) 
  • Viokace: Lipase 20,880 units), protease (78,300 units), amylase (78,300 units) 
more...

Pancreatic Insufficiency

>4 years

  • 500 lipase units/kg per meal initially (up to the maximum dose); half the prescribed dose given for an individualized full meal often administered with each snack; total daily dose should reflect approximately 3 meals plus 2 or 3 snacks/day
  • Dose should not exceed 2,500 lipase units/kg per meal; 10,000 lipase units/kg/day; or 4,000 lipase units/g of fat ingested per day

>12 months to < 4 years

  • 1,000 lipase units/kg per meal initially (up to the maximum dose); half the prescribed dose given for an individualized full meal often administered with each snack; total daily dose should reflect approximately 3 meals plus 2 or 3 snacks/day
  • Dose should not exceed 2,500 lipase units/kg per meal; 10,000 lipase units/kg/day; or 4,000 lipase units/g of fat ingested per day
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Interactions

Interaction Checker

and digestive enzymes

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     activity indicator 
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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Nausea

            Diarrhea

            Abdominal cramping

            Headache

            Neck pain

            Nasal congestion

            Peripheral edema

            Rash

            Dizziness

            Hypoglycemia

            Hyperglycemia

            Diabetes mellitus exacerbation

            Flatulence

            Dyspepsia

            Biliary tract stones

            Abnormal feces

            Hydrocholecystis

            Renal cyst

            Viral infection

            Asthma

            Gastritis

            Muscle spasm

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            Warnings

            Contraindications

            Hypersensitivity to any component

            Acute pancreatitis, acute exacerbation of chronic pancreatitis

            Cautions

            Dosage depends on condition being treated and digestive requirements of patients

            Fibrosing colonopathy advancing to colonic strictures reported

            Administering the contents of the capsules alone or mixing in food may irritation of the oral mucosa and or loss of enzyme activity

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Unknown; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Enzymes break down dietary

            • Carbohydrates: amylase, cellulase, pancreatin
            • Fats: bile salts, lipase, pancreatin
            • Proteins: pancreatin, pepsin, protease

            Pharmacokinetics

            Absorption: not absorbed, acts locally in GI tract

            Excretion: feces

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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