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Pancreatic Enzyme Pharmacotherapy
Marcus Ferrone, Pharm.D., Massimo Raimondo, M.D., and James S. Scolapio, M.D.
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.
Key Words: pancreatic enzymes, pancrelipase, pancreatitis, cystic fibrosis.