Names and pronunciation
(pan-kre-li′pase) Cotazym Creon, Pancrease MT , Pancreaze, Pertzye, Viokase, Zenpep
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Drug reference
(pan-kre-li′pase) Cotazym Creon, Pancrease MT , Pancreaze, Pertzye, Viokase, Zenpep
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Func. class.: Digestant
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Chem. class.: Pancreatic enzyme— bovine/porcine
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ACTION: Pancreatic enzyme needed for the breakdown of substances released from the pancreas
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USES: Exocrine pancreatic secretion insufficiency, due to cystic fibrosis (digestive aid), pancreatic enzyme deficiency
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CONTRAINDICATIONS: Allergy to pork, acute pancreatitis Precautions: Pregnancy, ileus, chronic pancreatitis, Crohn’s disease, diabetes mellitus, breastfeeding
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SIDE EFFECTS ENDO: Hypo/hyperglycemia GI: Anorexia, nausea, vomiting, diarrhea, cramping, bloating GU: Hyperuricuria, hyperuricemia
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INTERACTIONS Decrease: absorption—cimetidine, ant- acids, oral iron Decrease: effect of acarbose, miglitol
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DOSAGE AND ROUTES Pancreatic insufficiency due to pancreatectomy • Adult/adolescent/child ≥4 yr (del rel caps) Creon Caps, Zenpep Caps, Pancre- aze Caps: PO 500 lipase units/kg/meal, titrate based on patient response, max 2500 lipase units/kg/meal Cystic fibrosis • Adult/adolescent/child >4 yr: PO 500 lipase units/kg/meal, titrate based on re- sponse • Child 1-3 yr: PO 1000 lipase units/kg/ meal, titrate based on patient response, max 2500 lipase units/kg/meal • Neonates/infants: PO 2600 lipase units/120 mL of formula or breastfeeding (Pancreaze) or 3000 lipase units/120 mL of formula or breastfeeding (Creon, Zenpep)
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Available forms: Delayed-release cap- sule lipase 2600, 3000, 4000, 4200, 5000, 6000, 8000, 10,000, 10,500, 12,000, 15,000, 16,000, 16,800, 20,000, 20,800, 21,000, 24,000, 25,000, 36,000, 37,000, 40,000; Tablet lipase/amylase 10, 20 mg (vioKase)
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Administer: • After antacid or cimetidine; decreased pH inactivates product • Low-fat diet for GI symptoms • Have patient sit up during administra- tion; give with meals • Do not crush, chew del rel products, caps those with spheres, microspheres, or mi- crotablets may be opened and sprinkled on soft food • Follow PO dose with glass of water or juice, formula or breast milk for infants Delayed-release route • Given with meals, snacks, or sufficient fluid • Do not mix directly in formula • Viokase is not interchangeable with other products • Store in tight container at room tem- perature
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Assess: • Appropriate height, weight development before and periodically; may be delayed • I&O ratio; watch for increasing urinary output • Fecal fat, nitrogen, PT during treatment • Diabetes mellitus: for polyuria, poly- dipsia, polyphagia; monitor glucose level more frequently • Pork sensitivity; cross-sensitivity may occur • Adequate hydration • Pregnancy/breastfeeding: use only if clearly needed; do not breastfeed
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Evaluate: • Therapeutic response: improved di- gestion of carbohydrates, protein, fat; absence of steatorrhea
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To notify prescriber of allergic reac- tions, abdominal pain, cramping, or blood in urine • To always take with food; not to crush, chew del rel product, caps • To store at room temperature, away from moisture • Not to sprinkle capsule contents onto alkaline foods HIGH ALERT
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• Adult/adolescent/child ≥4 yr (del rel caps) Creon Caps, Zenpep Caps, Pancre- aze Caps: PO 500 lipase units/kg/meal, titrate based on patient response, max 2500 lipase units/kg/meal Cystic fibrosis
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• Adult/adolescent/child >4 yr: PO 500 lipase units/kg/meal, titrate based on re- sponse
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• Child 1-3 yr: PO 1000 lipase units/kg/ meal, titrate based on patient response, max 2500 lipase units/kg/meal
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