Pancreatic exocrine insufficiency

Initially 1-2 capsules with meals.

Initially 100mg (one measure) taken with each meal or immediately after.

Prescribing Notes:

Creon should be initiated on specialist advice.
Creon should be taken with food. It can be mixed with food or liquids, but these must not be excessively hot since it is inactivated by heat. Mixtures must be ingested within one hour.
Pancreatin can cause perioral and buccal irritation if retained in the mouth.
High doses of pancreatin can cause perianal irritation.
Creon is more effective when taken with concomitant PPIs, as pancreatin is inactivated by gastric acid.
It is important to ensure adequate hydration at all times in patients receiving higher strength pancreatin preparations.
There is great variation in patient response to pancreatin products. Fat malabsorption has the most bearing on the clinical picture. Theoretically 60,000 BPU of lipase should enable a completely achylic patient to digest the fat in a normal meal; the quantity of protease and amylase that comes with this dose of lipase is more than sufficient to digest the protein and carbohydrate.
Doses are adjusted to individual patient requirements and often this is by gradually increasing the dose.
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.

History Notes

15/12/2021

East Region Formulary content agreed.

For dose, refer to BNF for Children.

Prescribing Notes:

Creon should be initiated on specialist advice.
Pancreatin can cause perioral and buccal irritation if retained in the mouth.
High doses of pancreatin can cause perianal irritation.
Creon is more effective when taken with concomitant PPIs, as pancreatin is inactivated by gastric acid.
It is important to ensure adequate hydration at all times in patients receiving higher strength pancreatin preparations.
There is great variation in patient response to pancreatin products. Fat malabsorption has the most bearing on the clinical picture. Theoretically 60,000 BPU of lipase should enable a completely achylic patient to digest the fat in a normal meal; the quantity of protease and amylase that comes with this dose of lipase is more than sufficient to digest the protein and carbohydrate.
Doses are adjusted to individual patient requirements and often this is by gradually increasing the dose.
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.
Dose depends on stool consistency and frequency, weight gain and abdominal discomfort.
Creon Micro should only be used until the child is taking a dose of at least 10000units. The capsule contents can be sprinkled on a small amount of food, but these must not be excessively hot since it is inactivated by heat. The contents of Creon capsules must not be chewed. Mixtures must be ingested within one hour.
A dose of Creon at mealtimes may be divided and taken immediately before, during and after meals, especially in infants and young children in whom food intake may be unpredictable.
Children requiring pancreatic supplements will usually also need supplementary fat-soluble vitamins.

History Notes

30/08/2023

East Region Formulary content agreed - ERFC 09/08/2023.