Consumer’s Guide to Pancreatic Enzyme Replacement Therapy (PERT) Everyday Health Menu NewslettersSearch How to Manage EPI Exocrine Pancreatic Insufficiency The Consumer s Guide to Pancreatic Enzyme Replacement Therapy PERT Everything you need to know about PERT, the standard treatment for exocrine pancreatic insufficiency. By Julie StewartMedically Reviewed by Sanjai Sinha, MD Reviewed: March 17, 2021 Medically Reviewed I f you have 5 Essential Facts About PERT for EPI The more you know about PERT, the more comfortable you may feel taking these medications. 1 There are six PERT medications that have been approved by the Food and Drug Administration FDA to treat EPI Creon became the first PERT to receive FDA approval, in 2009, but since then, other brands — Zenpep, Pancreaze, Ultresa, Viokace, and Pertzye — have become available. All of these medications contain pancrelipase, a mix of enzymes (lipase, protease, and amylase) that are normally secreted by the pancreas. 2 PERT comes in capsules The pills come in different sizes, each labeled with a number that designates how much lipase is inside, says 3 You need to take PERT with food The enzymes need to mix with the food you eat so you can digest it, says Dr. Freedman. A normal, well-functioning pancreas would secrete enzymes into your upper intestine as soon as you started to eat so the enzymes would come in contact with your food, he says. 4 Some people begin to feel better shortly after starting PERT One common EPI symptom, oily stools (steatorrhea), can improve within a day of starting PERT, says Freedman. Gas and bloating can improve within a few days, and within a week or two, people who’ve unintentionally lost weight because of EPI might notice their weight inching back up. 5 The medication can be costly “If you don’t have a strong prescription drug plan, it can be $1,000 to $2,000 a month to buy it,” says Dr. Forsmark. “There are no generics.” Review your coverage carefully to see which PERT options your insurance will pay for, and check GoodRx for coupons. Save these PERT facts Download now Common Questions About PERT for EPI When you start taking PERT, you might have questions. Here are a few of the most common concerns, answered by experts. Get the answers to common PERT questions Download now 5 Things to Know About PERT Doses If you start taking PERT, it’s critical to take the right dose at the right time. Here’s what to know about dosing. 1 How do I know what dose to take Your doctor will help you determine your dose based on how well your pancreas is functioning, says Freedman. Say you’re taking a capsule with 24,000 or 25,000 units of lipase, for example. A person with mild EPI might only need two capsules with the first bite of each meal; someone with moderate EPI might need four or five; and someone with severe EPI might need seven or more capsules per meal, he says. (These are just examples. Talk with your doctor about what works for your specific case.) 2 How much should I take for a meal versus a snack Your doctor should explain how to calibrate your dose based on the size of your meal or snack and how much fat is in the food. For example, if you’re eating pizza, you might take more than double the capsules you’d take with a light, low-fat meal, says Freedman. This strategy helps you mimic the response of a functioning pancreas, which releases more enzymes during larger or fattier meals. “Your pancreas is quite clever, so it grades how much food is being consumed, and that dictates how much it secretes,” he says. “The larger the meal, the more enzymes are secreted.” 3 What happens if I take PERT too early before a meal Let’s say you’re at a restaurant, and you pop your PERT a half hour before your food comes out. By the time you eat, your food won’t make contact with the enzymes, and you won’t get the benefits of the medication, says Freedman. To help people time their doses correctly, Freedman asks them how long it usually takes them to eat. If they take about 15 to 20 minutes to eat a typical meal, he usually tells them to take all their capsules with their first bite. If they take 30 minutes per meal, he usually advises taking half with the first bite and the other half 15 to 20 minutes in. If someone plans to enjoy a meal over an hour, he tells them to take a third of their capsules with the first bite, a third in the middle of a meal, and a third toward the end. 4 What happens if I forget to take my digestive enzymes If you’re just finishing a meal and realize you forgot your PERT, take your enzymes immediately, says Freedman. If you stopped eating an hour ago, it’s too late. Don’t let this become a pattern: Work on developing habits to bring capsules with you wherever you go. Forgetting to take PERT after one meal may not pose much of a problem, says Freedman, but if you start missing a lot of meals, you could start losing weight — something that might be problematic for your health. 5 How can I make sure I always have a dose on hand Keep them in your pocket or stash a supply in every bag you carry, says Freedman. This way, you’ll never be without them. “You have to just figure out, Where can I put my capsules so that when I’m about to eat my meal, I have ready access to them?” he says. One place you shouldn’t stash your enzymes is a hot car, because extreme heat will degrade their function. Keep these facts on hand Download now Next Steps Making EPI Treatment Decisions Congratulations You’ve learned a lot about PERT. Maybe it’s working for you, or maybe you need to adjust your dosage or make some other changes. Here’s how to assess how you’re doing and prepare helpful questions to ask your doctor. Questions to Ask Yourself 1 Are my EPI symptoms better or worse For example, many people with EPI have oily stools that stick to the walls of the toilet bowl, says Freedman. Is that improving? Is your gas and bloating less problematic than before? Are you regaining weight? 2 Am I downplaying my GI symptoms when I talk to my doctor “For a lot of medical conditions, it’s a little embarrassing to talk about the symptoms, but that’s why you’re there to see the doctor,” says Forsmark. “Don’t hold anything back. Bring it all forward.” If you don’t speak honestly, then your doctor won’t be able to accurately assess if your therapy is working — or not working — and can’t help you get better. 3 Do I feel stronger As PERT takes effect, people often notice an improvement in their muscle mass and function, says Forsmark. As a result, they feel stronger and more energized, and they can be more active without tiring out. 4 Do I feel healthier overall EPI can lead to deficiencies in fat-soluble vitamins, and PERT can help people boost their levels of these nutrients, says Forsmark. “If their vitamin A level improves, they might notice that their night vision is better,” he says. “If their vitamin E level improves, they may notice their skin feels better and looks better.” Save these self-reflection questions Download now Questions to Ask Your Doctor At your next appointment, have an honest, thorough conversation with your healthcare provider. Here are some questions to consider. 1 Are my symptoms responding well to the enzymes Review whether your EPI symptoms, such as gas, bloating, and steatorrhea, are improving, and if so, by how much, says Freedman. Your doctor can help you determine if you are responding as expected and whether any remaining symptoms are from EPI or another cause, such as small intestinal bacterial overgrowth. 2 Am I taking the right dose If you’re doing exceptionally well, your doctor might suggest reducing your dose to see if you experience the same benefits with fewer capsules, says Freedman. If your symptoms haven’t fully improved, then your doctor might recommend a higher dose. In a study of medical records, Forsmark and colleagues found that among people with chronic pancreatitis who took PERT, about two-thirds were prescribed a dose that was too low. 3 Am I taking my dose at the right time Sometimes people don’t receive clear directions from their healthcare providers, or they pick up a pill bottle at the pharmacy that just directs them to take the pills a certain number of times per day, says Forsmark. Make sure you understand exactly when and how you are supposed to be taking your enzymes. 4 Do I need to adjust my diet While people with cystic fibrosis tend to do well on a high-fat diet, others with EPI find that a low-fat diet helps ease bloating, gas, and oily stools, says Freedman. If a particular food causes bloating and loose stools, it’s smart to avoid it, says Forsmark. In general, he recommends a heart-healthy low-fat diet but warns that extreme diets could backfire. “I have patients that come in that are on such low-fat diets that they become even more deficient in those fat-soluble vitamins, so I don’t recommend those very, very low-fat diets,” he says. It's critical to talk to your doctor before making any dietary changes. 5 What other lifestyle changes can I make to better manage my EPI Your doctor might recommend other habits that can help you, including quitting smoking and reducing alcohol intake, which can cause chronic pancreatitis. Save these doctor questions for your next appointment Download now Most Recent in Exocrine Pancreatic Insufficiency What Happens When You Aren t Treated for EPI 3 Steps to Treating Exocrine Pancreatic Insufficiency What to Know About Pancreatic Enzyme Replacement Therapy 6 Tips to Help You Remember to Take Your Exocrine Pancreatic Insufficiency Medication Wellness inspired Wellness enabled FacebookTwitterInstagramPinterestYoutubeTikTok About Us Careers Editorial Policy Newsletters Meet Our Health Expert Network Privacy Policy Health News Accessibility Statement Terms of Use Contact Us Feedback Do Not Sell My Personal Information Popular Topics AdChoices NEWSLETTERS Get the best in health and wellness SubscribeBy subscribing you agree to the Terms of Use and Privacy Policy. A PROPERTY OF EHGLogo More From Everyday Health: Castle Connolly Top Doctors DailyOM Diabetes Daily Everyday Health Care Migraine Again 1996-2022 Everyday Health, Inc. 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