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Higher-strength preparations
The high-strength pancreatin preparations
Nutrizym
22
c
and
Pancreatin HL
c
have been associated with
the development of
large bowel
strictures (fibrosing
colonopathy)
in children with cystic fibrosis
aged
between 2 and 13 years.
No association was found
with
Creon
c
25 000
and
Creon
c
40 000
.
The follow-
ing is recommended:
.
Pancrease HL
c
and
Nutrizym 22
c
should not be
used in children aged 15 years or less with cystic
fibrosis;
.
the total
dose of
pancreatic enzyme supplements
used in patients
with cystic fibrosis
should not
usually exceed 10 000 units of
lipase per kg body-
weight daily;
.
if a patient on any pancreatin preparation develops
new abdominal
symptoms (or any change in exist-
ing abdominal
symptoms)
the patient
should be
reviewed to
exclude
the
possibility
of
colonic
damage.
Possible risk factors are gender (boys at greater risk
than girls),
more severe cystic fibrosis,
and concomi-
tant
use of
laxatives.
The peak age for developing
fibrosing colonopathy is between 2 and 8 years.
Counselling
It is important to ensure adequate hydration at all
times in patients receiving higher-strength pancreatin pre-
parations.
Creon
c
25 000
(Solvay) A
Capsules
,
orange/clear,
enclosing brown-coloured
e/c pellets of pancreatin (pork),
providing:
protease
(total) 1000 units,
lipase 25 000 units,
amylase
18 000 units,
net price 100-cap pack = £28.25.
Coun-
selling,
see above and under dose
Dose
ADULT and CHILD initially 1 capsule with meals either taken
whole or contents mixed with fluid or soft food (then swallowed
immediately without chewing)
Creon
c
40 000
(Solvay) A
Capsules
,
brown/clear,
enclosing brown-coloured
e/c granules of pancreatin (pork), providing: protease
(total) 1600 units,
lipase 40 000 units,
amylase
25 000 units,
net price 100-cap pack = £60.00.
Coun-
selling,
see above and under dose
Dose
ADULT and CHILD initially 1–2 capsules with meals either
taken whole or contents mixed with fluid or soft food (then
swallowed immediately without chewing)
Nutrizym 22
c
(Merck Serono) A
Capsules
,
red/yellow,
enclosing e/c minitablets of
pancreatin (pork),
providing minimum of:
protease
1100 units,
lipase 22 000 units,
amylase 19 800 units.
Net price 100-cap pack = £33.33.
Counselling,
see
above and under dose
Dose
ADULT and CHILD over 15 years, 1–2 capsules with meals
and 1 capsule with snacks, swallowed whole or contents taken
with water or mixed with soft food (then swallowed immediately
without chewing)
Pancrease HL
c
(Janssen-Cilag) A
Capsules
,
enclosing light brown e/c minitablets of
pancreatin (pork),
providing minimum of:
protease
1250 units,
lipase 25 000 units,
amylase 22 500 units.
Net price 100 = £31.70.
Counselling,
see above and
under dose
Dose
ADULT and CHILD over 15 years,
1–2 capsules during each
meal and 1 capsule with snacks swallowed whole or contents
mixed with slightly acidic liquid or soft food (then swallowed
immediately without chewing)
80
1.9.4 Pancreatin
BNF 61
1
Gastro-intestinal system