page99
divided doses,
then adjusted as required;
max.
36 g
daily;
CHILD
1–18 years see
BNF for Children
Counselling
Other drugs should be taken at
least
1 hour
before or 4–6 hours after colestyramine to reduce possible
interference with absorption
Note
The contents of each sachet should be mixed with at
least 150 mL of water or other suitable liquid such as fruit
juice, skimmed milk, thin soups, and pulpy fruits with a high
moisture content
Preparations
Section 2.12
1.9.3
Aprotinin
Aprotinin is no longer used for the treatment of
acute
pancreatitis.
1.9.4
Pancreatin
Supplements of pancreatin are given by mouth to com-
pensate for
reduced or
absent
exocrine secretion in
cystic fibrosis,
and following pancreatectomy,
gastrec-
tomy,
or chronic pancreatitis.
They assist the digestion
of
starch,
fat,
and protein.
Pancreatin may also be
necessary if a tumour (e.g. pancreatic cancer) obstructs
outflow from the pancreas.
Pancreatin is inactivated by gastric acid therefore pan-
creatin preparations are best taken with food (or imme-
diately before or after food). Gastric acid secretion may
be reduced by giving cimetidine or ranitidine an hour
beforehand (section 1.3).
Concurrent
use of
antacids
also reduces gastric acidity. Enteric-coated preparations
deliver a higher enzyme concentration in the duodenum
(provided the capsule contents are swallowed whole
without
chewing).
Higher-strength
preparations
are
also available (important: see CSM advice below).
Since pancreatin is also inactivated by heat,
excessive
heat should be avoided if preparations are mixed with
liquids or food; the resulting mixtures should not be kept
for more than one hour.
Dosage is
adjusted according to size,
number,
and
consistency of
stools,
so that the patient thrives;
extra
allowance will
be needed if
snacks are taken between
meals.
Pancreatin can irritate the perioral
skin and buccal
mucosa if
retained in the mouth,
and excessive doses
can cause perianal
irritation.
The most
frequent
side-
effects are gastro-intestinal, including nausea, vomiting,
and abdominal
discomfort;
hyperuricaemia and hyper-
uricosuria have been associated with very high doses.
Hypersensitivity reactions occur occasionally and may
affect those handling the powder.
PANCREATIN
Indications
see above
Cautions
see above and (for higher-strength prepara-
tions) see below
Pregnancy
not known to be harmful
Side-effects
see above and (for higher-strength pre-
parations) see below
Dose
. See preparations
Creon
c
10 000
(Solvay)
Capsules
,
brown/clear,
enclosing buff-coloured e/c
granules of pancreatin (pork),
providing:
protease
600 units, lipase 10 000 units, amylase 8000 units. Net
price 100-cap pack = £12.93.
Counselling,
see dose
Dose
ADULT and CHILD initially 1–2 capsules with each meal
either taken whole or contents mixed with fluid or soft food (then
swallowed immediately without chewing)
Creon
c
Micro
(Solvay)
Gastro-resistant granules
, brown, pancreatin (pork),
providing:
protease 200 units,
lipase 5000 units,
amy-
lase 3600 units per 100 mg,
net price 20 g = £31.50
Counselling,
see dose
Dose
ADULT and CHILD initially 100 mg with each meal either
taken whole or mixed with acidic fluid or soft food (then swal-
lowed immediately without chewing)
Nutrizym 10
c
(Merck Serono)
Capsules
,
red/yellow,
enclosing e/c minitablets of
pancreatin (pork),
providing minimum of:
protease
500 units, lipase 10 000 units, amylase 9000 units. Net
price 100 = £14.47.
Counselling,
see dose
Dose
ADULT and CHILD 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);
higher doses may be required according to response
Pancrex
c
(Paines & Byrne)
Granules
,
pancreatin (pork), providing minimum of:
protease 300 units,
lipase 5000 units,
amylase
4000 units/g.
Net price 300 g = £20.39.
Label:
25,
counselling,
see dose
Dose
ADULT and CHILD 5–10 g just before meals washed down or
mixed with a little milk or water
Pancrex V
c
(Paines & Byrne)
Capsules
,
pancreatin (pork), providing minimum of:
protease 430 units,
lipase 8000 units,
amylase
9000 units.
Net price 300-cap pack = £15.80.
Coun-
selling,
see dose
Dose
ADULT and CHILD over 1 year 2–6 capsules with each meal,
swallowed whole or sprinkled on food; INFANT up to 1 year
contents of 1–2 capsules mixed with feeds
Capsules ‘125’
,
pancreatin (pork),
providing mini-
mum of: protease 160 units, lipase 2950 units, amylase
3300 units,
net price 300-cap pack = £9.72.
Counsel-
ling,
see dose
Dose
NEONATE contents of 1–2 capsules mixed with feeds
Tablets
,
e/c,
pancreatin (pork),
providing minimum
of:
protease 110 units,
lipase 1900 units,
amylase
1700 units.
Net price 300-tab pack = £4.51.
Label:
5,
25,
counselling,
see dose
Dose
ADULT and CHILD 5–15 tablets before each meal
Tablets forte
,
e/c,
pancreatin (pork), providing mini-
mum of: protease 330 units, lipase 5600 units, amylase
5000 units. Net price 300-tab pack = £13.74. Label: 5,
25,
counselling,
see dose
Dose
ADULT and CHILD 6–10 tablets before each meal
Powder
,
pancreatin (pork), providing minimum of:
protease 1400 units,
lipase 25 000 units,
amylase
30 000 units/g. Net price 300 g = £24.28. Counselling,
see dose
Dose
ADULT and CHILD over 1 month, 0.5–2 g before each meal,
washed down or mixed with liquid;
NEONATE 250–500 mg with
each feed
BNF 61
1.9.3 Aprotinin
79
1
Gastro-intestinal system