If a patient on any pancreatin preparation develops new abdominal symptoms (or any change in existing abdominal symptoms) the patient should be reviewed to exclude the possibility of colonic damage.

National Patient Safety Alert (24 May 2024): Shortage of Pancreatic enzyme replacement therapy (PERT)

• There are limited supplies of pancreatic enzyme replacement therapies (PERT) (dates updated from SPS Medicines Supply Tool):
  • Creon 10,000 and 25,000 capsules are in limited supply until 2026.
  • Nutrizym 22 capsules supply issue has been resolved and are available.
  • Pancrex V capsules are out of stock until June 2025.
  • Pancrex V 125mg capsules are out of stock until end of December 2024.
  • Pancrex V oral powder is out of stock until beginning of November 2024.

Actions required by clinicians:

• Prescribe a maximum of one month’s supply of PERT for all patients at a time.
• Prioritise Creon 10,000 capsules for patients unable to take Creon 25,000 capsules only. Where patients are prescribed Creon 10,000 due to swallowing difficulties, consider the suitability of prescribing Creon 25,000 capsules which may be opened and mixed (without crushing) with soft acidic food. Refer to the NPSA for further information and counselling of patients.
• Prioritise Nutrizym 22 capsules for patients unable to tolerate Creon capsules.
• Where PERT is prescribed for indications other than cystic fibrosis, refer to the NPSA for options to consider and clinical advice in this position statement, endorsed by professional bodies.
• Seek advice from a specialist on alternative treatments if above options are not suitable.

Updated advice on switching between products for adults and children can be found on the SPS mini-tool: Prescribing and ordering available pancreatic enzyme replacement therapies.

Creon

(Pancreatin)

• Capsules containing gastro-resistant granules 10,000 (£12.93 = 100 capsules)
  • Amylase 8,000 unit
  • Lipase 10,000 unit
  • Protease 600 unit
• Capsules containing gastro-resistant granules 25,000 (£28.25 = 100 capsules)
  • Amylase 18,000 unit
  • Lipase 25,000 unit
  • Protease 1,000 unit

Indications

• For the treatment of pancreatic exocrine insufficiency

Dose

• Adults and children (over 2 years): Initially 1-2 capsules to be taken with each meal either whole or contents mixed with acidic fluid or soft food (then swallowed immediately without chewing)

Notes

1. National Patient Safety Alert (24 May 2024): Shortage of Pancreatic enzyme replacement therapy (PERT)
   1. Creon 10,000 and 25,000 capsules are in limited supply until 2026. 
   2. See above for advice on managing patients.
2. If opening the capsules for administration, granules mixed with fluid or food should be taken immediately and the mixture not stored.
3. Do not crush or chew granules.

Pancrex V

(Pancreatin)

• Oral powder (£246.40 = 300g container)
  • Amylase 30,000 unit per gram powder
  • Lipase 25,000 unit per gram powder
  • Protease 1,400 unit per gram powder

Indications

• For the treatment of pancreatic exocrine insufficiency in patients requiring enteral feeding

Dose

• Adults and children: 0.5 - 2 grams swallowed dry or mixed with a little water or milk before each snack or meal
• New-born infants: 0.25 - 0.5 grams with each feed

Notes

1. National Patient Safety Alert (24 May 2024): Shortage of Pancreatic enzyme replacement therapy (PERT)
   1. Pancrex V oral powder is out of stock until beginning of November 2024. 
2. Pancrex V oral powder may be administered via a nasogastric tube or a gastrostomy tube.
3. Where enteral feeding is no longer required, patients should be reviewed to consider a switch to Creon capsules for ongoing treatment.
4. 1 gram of powder corresponds approximately to the volume of a 1.25 ml spoonful.
5. 2 grams of powder correspond approximately to the volume of a 2.5 ml spoonful.