PANCRELIPASE

(pan-kre-li'pase)

Cotazym, Cotazym-S, Festal II, Ilozyme, Ku-Zyme-Hp, Pancrease, Ultrase, Viokase
Classifications: enzymes; enzyme replacement therapy;
Therapeutic: pancreatic enzyme replacement therapy
Pregnancy Category: C

Availability

Tablets or capsules containing lipase, protease, and amylase

Action

Pancreatic enzyme concentrate of porcine origin standardized for lipase content. Similar to pancreatin but on a weight basis has 12 times the lipolytic activity and at least 4 times the trypsin and amylase content of pancreatin.

Therapeutic Effect

Facilitates the hydrolysis of fats into glycerol and fatty acids, starches into dextrins and sugars, and proteins into peptides for easier absorption.

Uses

Replacement therapy in symptomatic treatment of malabsorption syndrome due to cystic fibrosis and other conditions associated with exocrine pancreatic insufficiency.

Contraindications

History of allergy to porcine protein or enzymes; esophageal strictures; pancreatitis; pregnancy (category C).

Cautious Use

GI disease, Crohn's disease, short bowel syndrome; CF; lactation.

Route & Dosage

Pancreatic Insufficiency
Adult: PO 1–3 capsules or tablets or 1–2 packets of powder 1–2 h before, during, or 1 h after meals, with an extra dose taken with any food eaten between meals
Child: PO 1–2 capsules or tablets 1–2 h before, during, or 1 h after meals, with an extra dose taken with any food eaten between meals

Administration

Oral

Ensure that enteric-coated preparations are not crushed or chewed.
Note: For children, powder form may be sprinkled on food.
Open capsule and sprinkled contents on soft food, which should be swallowed without chewing to prevent mucus membrane irritation. Follow with a full glass of water or juice. Cimetidine, ranitidine, or an antacid may be prescribed to be given before pancrelipase to prevent drug's destruction by gastric pepsin and acid pH.
Determine dosage in relation to fat content in diet (suggested ratio: 300 mg pancrelipase for each 17 g dietary fat).

Adverse Effects (≥1%)

GI: Anorexia, nausea, vomiting, diarrhea. Metabolic: Hyperuricosuria.

Interactions

Drug: Iron absorption may be decreased.

Pharmacokinetics

Absorption: Not absorbed. Distribution: Acts locally in GI tract. Elimination: In feces.

Nursing Implications

Assessment & Drug Effects

Monitor I&O and weight. Note appetite and quality of stools, weight loss, abdominal bloating, polyuria, thirst, hunger, itching. Pancreatic insufficiency is frequently associated with steatorrhea, bulky stools, and insulin-dependent diabetes.

Patient & Family Education

Learn proper timing of medication in relation to meals.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

(249)