Pancreatin

An enzyme preparation from the pancreas of pigs and cattle. Amorphous fine powder of grayish or yellowish color with a characteristic odor. Slightly soluble in water.

In the acidic environment of the stomach, pancreatin rapidly loses activity, therefore it is usually released in the enteric coating. It is activated in the intestine at pH = 5.5. The average dose for adults is 150 thousand units / day. ^[2]

Preparations containing pancreatic enzymes can be classified:

• In composition. Pure pancreatin, as well as containing additional substances, can be used. This parameter determines the indications and contraindications (additional components have their contraindications):
  • pancreatin and choleretic agent;
  • pancreatin, components of bile , hemicellulase;
  • pancreatin and rice fungus extract;
  • combined enzymes.
• By resistance to hydrochloric acid of the stomach . Determines the effectiveness of the drug (in the acidic environment of the stomach, pancreatin loses its activity).
• By particle size of the drug. It affects the effectiveness and physiology of the drug (a particle diameter of less than 2 mm ensures a synchronous flow of the drug with the chyme into the duodenum ).
  • conventional tablets;
  • microgranular forms (produced in the form of gelatin capsules in which acid-resistant microspheres or microtablets with a diameter of less than 2 mm are placed).

Comparison of some brands ^[2]

Digestive enzyme remedy, compensates for the deficiency of pancreatic enzymes, has a proteolytic, amylolytic and lipolytic effect. Pancreatic enzymes ( lipase , alpha-amylase , trypsin , chymotrypsin ) contribute to the breakdown of proteins to amino acids, fats to glycerol and fatty acids , starch to dextrins and monosaccharides, improves the functional state of the digestive tract, and normalizes digestion processes.

Trypsin suppresses the stimulated secretion of the pancreas , providing an analgesic effect.

Pancreatic enzymes are released from the dosage form in the alkaline environment of the small intestine, as they are protected from the action of gastric juice by the membrane.

The maximum enzymatic activity of the drug is noted 30–45 minutes after oral administration. ^[3]

Lack of exocrine pancreatic function (chronic pancreatitis , cystic fibrosis ). Chronic inflammatory and dystrophic diseases of the stomach, intestines, liver , gall bladder , conditions after resection or irradiation of these organs, accompanied by disorders of digestion, flatulence , diarrhea (as part of Pancreatinum 8000 Table. No. 50 of combination therapy). To improve the digestion of food in people with normal gastrointestinal function in case of errors in nutrition, as well as with violations of chewing function. Preparation for x-ray and ultrasound examination of the abdominal organs. ^[3]

The dose is selected individually depending on the degree of pancreatic function insufficiency. The drug is used in adults at a dose of 1–4 tablets (which corresponds to 8000–32000 units of FIP by lipase) with each meal. Prescribe tablets inside during or after a meal, without chewing, with a large amount of liquid, preferably not alkaline: water, fruit juices. The daily dose of 6-18 tablets (48000-150000 UNITS FIP). With complete insufficiency of pancreatic function (for example, cystic fibrosis), the dose should be increased to 49 tablets (400,000 units of FIP) per day, which corresponds to the daily requirement of an adult for lipase. The course of treatment can last from several days (if the digestive process is disturbed due to errors in the diet) to several months or even years (if necessary, in constant replacement therapy). ^[3]

The effectiveness of enzyme preparations depends on the form of release (tablet or capsules with minimicrospheres / microtablets), particle size (less than 2 mm), resistance to the acidic environment of the stomach, and the rate of release of enzymes in the duodenum. For the correction of exocrine pancreatic insufficiency (according to the latest recommendations), capsules containing microspheres and minimicrospheres are recommended. Drugs with bile cannot be used in patients with biliary tract diseases and hepatitis ^[4] .

When used very rarely, a hypersensitivity reaction is possible. With prolonged use of high doses of the drug, hyperuricosuria may occur. Symptoms of intestinal obstruction, stricture of the small intestine may appear. ^[3] . Possible allergic reactions of an immediate type (with cystic fibrosis, especially in children) ^[5] .

In a dry, dark place at a temperature below 25 ° C ^[6] .