saudigastro.com/patients/pancreatic-enzyme-replacement
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
Drug class
Pancreatic enzyme replacement therapy (PERT)
Examples
Pancrelipase capsules containing lipase, protease and amylase
How it works
The pancreas makes enzymes that break down fat, protein and starch in food. When it cannot make enough (exocrine pancreatic insufficiency), food is not digested properly, causing greasy stools, weight loss and vitamin shortages. The capsules contain these enzymes in tiny coated beads that open in the small intestine, where they mix with food and digest it.
What it treats
- Pancreatic insufficiency after chronic pancreatitis
- Pancreatic insufficiency in cystic fibrosis
- Insufficiency after pancreatic surgery or in some pancreatic cancers
- Some other causes of fat malabsorption, as decided by your doctor
How to take it
Take the capsules with the first bites of a meal or snack, not before or long after. For large meals, many people take part at the start and part during the meal. Swallow capsules whole with a drink; do not crush or chew the beads, because stomach acid can destroy them and the mouth can be irritated. If you cannot swallow capsules, ask your pharmacist how to open them and sprinkle the beads on a small amount of soft, slightly acidic food such as apple purée, and swallow without chewing. The amount depends on your meal size and fat content and is set by your doctor or dietitian. If you skip a meal, skip the capsules.
Common side effects
- Stomach pain, bloating or gas, especially while the dose is being adjusted
- Nausea or loose stools
- Constipation in some people
- Irritation around the mouth or anus if the beads are chewed or left on the skin
Serious side effects — call your doctor
Rash, wheeze, or swelling of the face, lips or throat
Could be a serious allergic reaction, particularly in people sensitive to pork products. Call emergency services or go to the emergency department now.
Severe or worsening belly pain, repeated vomiting, a hard swollen belly, or not passing stool or wind
Rarely, narrowing or blockage of the bowel can occur (more often with very high doses in cystic fibrosis). Go to the emergency department.
Severe upper belly pain spreading to the back, with vomiting
Could be a pancreatitis flare. Seek urgent medical care.
Joint pain, swelling or very high blood sugar readings if you have diabetes
Uncommon reactions; tell your doctor promptly. Very high sugars with vomiting or drowsiness need urgent care.
Interactions
Acid-reducing medicines can sometimes help the enzymes work better in people who still have symptoms; your doctor may add one. Antacids containing calcium or magnesium may reduce their effect for some people. Ask your doctor or pharmacist about iron and any other supplements. Most capsules are made from pork-derived enzymes, which matters to people who avoid pork for religious or personal reasons or who have an allergy: ask your doctor and pharmacist to discuss the options available to you.
Monitoring
Your doctor and dietitian will check whether your stools, weight, belly symptoms and nutrition improve, and may check vitamin levels (A, D, E, K) and, in some cases, other tests. The dose is adjusted until symptoms are controlled; this can take time.
When and how to stop
Treatment is usually long term, because the pancreas does not usually recover. Do not stop on your own; if it is not working or causes problems, ask your doctor to review the dose and timing.
Pregnancy & breastfeeding
These enzymes are not absorbed into the blood and are generally used in pregnancy when needed, since good nutrition matters for mother and baby. Discuss with your doctor.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- How many capsules should I take with meals, snacks and milky drinks?
- How will I know if the dose is right?
- Do I need vitamin supplements or a dietitian?
- Are there options if I do not take pork-derived products?
- How should I store the capsules, and what if I forget a dose?
Was this guide helpful?
Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide