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- What are oral digestive enzymes?
- What conditions are digestive enzymes (PEPs) used to treat?
- What are the side effects of oral digestive enzymes?
- Which drugs interact with oral digestive enzymes?
- Are oral digestive enzymes available over-the-counter (OTC)?
- 55 examples of prescription oral digestive enzymes (list)
- What formulations of oral digestive enzymes are available?
- Are taking oral digestive enzymes during pregnancy or while breastfeeding safe?
What are oral digestive enzymes?
Oral digestive enzymes are complex proteins naturally produced by the body to help digest and breakdown the foods we eat. The pancreas is the organ responsible for making and secreting digestive enzymes. Oral digestive enzymes are used when the pancreas is unable to produce enough digestive enzymes.
The main digestive enzymes are:
- Proteases for digesting proteins
- Lipases for digesting fats
- Amylases for digesting carbohydrates
These digestive enzymes are available in pancreatic enzyme products (PEPs).
What conditions are digestive enzymes (PEPs) used to treat?
PEPs are used in people with pancreatic diseases, for example:
- Cystic fibrosis
- Shwachman-Diamond syndrome
- Chronic pancreatitis
- Pancreatic cancer or tumors
- Removal of all or part of the pancreas
Additionally, PEPs may be used in gastrointestinal disorders, for example:
What are the side effects of oral digestive enzymes?
Although rare, some patients can experience life-threatening allergic reactions when taking this medicine. Patients should stop their medication immediately and seek emergency medical help if they have any of the following signs or symptoms.
- Difficulty breathing or talking
- Swelling of the mouth, face, lips, tongue, or throat
- Chest tightness
- Rash or hives
- Red, swollen, blistered, or peeling skin
Other side effects of digestive enzymes include:
- Stomach pain
- Sore throat
- Upset stomach
- Nausea or vomiting
- Neck pain
- Stuffy nose
- Ear pain
This medication can increase the risk of developing a rare but serious bowel problem called fibrosing colonopathy in which there is localized inflammation and scarring in the colon. Patients are advised to call their doctor right away if they have very bad
Many digestive enzymes are derived from pork and therefore, should not be used by patients who are allergic to pork.
Which drugs interact with oral digestive enzymes?
- The effectiveness of oral digestive enzymes may decrease when they are given with calcium or magnesium containing antacids.
- Digestive enzymes containing amylase or other carbohydrate digesting enzymes may reduce the effectiveness of alpha-glucosidase inhibitors (for example, acarbose (Precose), miglitol [Glyset]), a class of oral anti-diabetes medications that are used to reduce the activity of the carbohydrate digesting enzymes.
Are oral digestive enzymes available over-the-counter (OTC)?
Digestive enzymes are available over-the-counter (OTC) or by prescription.
- OTC products are not approved by the FDA and should not be used with the intent to cure or treat any aliments.
- OTC digestive enzymes are mainly used as a dietary supplements to help with digestion.
- OTC dietary supplements are not regulated by the FDA and may contain impurities and varying quantities of active ingredients.
A person should speak to their doctor or pharmacist if he/she is interested in starting an OTC regimen.
Prescription digestive enzymes come in various formulations and may contain different amounts of individual digestive enzymes. Therefore, prescription digestive enzymes are not clinically interchangeable and are not considered bioequivalent by the FDA.
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55 examples of prescription oral digestive enzymes (list)
- Pancreatin (Ku-Zyme, Kutrase, Lapase)
- Pancrelipase (Cotazym S, Creon
- Creon (Lipase 24,000 unit)
- Creon (Lipase 3,000 unit)
- Creon (Lipase 12,000 unit)
- Creon (Lipase 6,000 unit)
- Creon 10
- Creon 20
- Creon 5
- Ku-Zyme HP
- Lipram 10,000
- Pancrease MT 10
- Pancrease MT 16
- Pancrease MT 20
- Pancrease MT 4
- Pancrecarb MS-16
- Pancrecarb MS-4
- Pancrecarb MS-8
- Pancron 10
- Pancron 20
- Pangestyme CN 10
- Pangestyme CN 20
- Pangestyme EC
- Pangestyme MT16
- Pangestyme UL12
- Pangestyme UL18
- Pangestyme UL20
- Panocaps MT-16
- Panocaps MT-20
- Panokase 16
- Ultracaps MT-20
- Ultrase MT 12
- Ultrase MT 18
- Ultrase MT20
- Zenpep (Lipase 10,000 unit)
- Zenpep (Lipase 15,000 unit)
- Zenpep (Lipase 20,000 unit)
- Zenpep (Lipase 25,000 unit)
- Zenpep (Lipase 3,000 unit)
- Zenpep (Lipase 5,000 unit)
What formulations of oral digestive enzymes are available?
- Oral, delayed release capsules are enteric coated to help prevent the capsules from breaking down in the stomach. Enteric coating delays the release of the enzymes until it reaches the lower gastrointestinal tract where its activity is desired.
- Oral capsules are non-enteric coated capsules and must be taken with a proton pump inhibitor (PPI), a medicine that lowers stomach acidity that can destroy the enzymes.
- Digestive enzymes are also available as oral mini-microsphere delayed-release capsules, tablet, and powder.
Are taking oral digestive enzymes during pregnancy or while breastfeeding safe?
Oral digestive enzymes have not been adequately studied in pregnant women. Oral digestive enzymes should only be used during pregnancy if the potential benefits to the mother outweigh the potential risks to the unborn baby.
It is not known whether oral digestive enzymes are excreted into breast milk. Pancreatic enzymes mostly act locally in the gastrointestinal tract and are generally not absorbed into the blood stream to make its way to the fetus.
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Oral digestive enzymes are found in the digestive tract, are naturally produced by the body, and help breakdown the foods we eat. The pancreas makes and secretes digestive enzymes. Prescription and OTC digestive enzymes are available in PEPs or pancreatic enzyme products. PEPs are prescribed for people with cystic fibrosis, chronic pancreatitis, pancreatic cancer or tumors, Shwachman-Diamond syndrome, or removal of part or all of the pancreas. Side effects, drug interactions, dosing, storage, and pregnancy and breastfeeding information should be reviewed prior to taking any medication.
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Crohn's disease is a chronic inflammatory disease, primarily involving the small and large intestine, but which can affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are common symptoms.
Cystic fibrosis is a disease of the mucus and sweat glands. Cystic fibrosis is an inherited disease. The outcome of the disease leaves the body malnourished, with bulky and fouls smelling stools, vitamin insufficiency, gas, painful or swollen abdomen, infertility, susceptible to heat emergencies, and respiratory failure. There is no cure for cystic fibrosis, treatment of symptoms is used to manage the disease.
Pancreatic cancer is a malignant tumor of the pancreas. Pancreatic cancer has been called a "silent" disease because early pancreatic cancer usually does not cause early symptoms. Typically, pancreatic cancer has metastasized (spread to adjacent organs, such as the liver) by the time most people receive a dignosis of pancreatic cancer. Symptoms and signs usually appear later in the course of the disease and include jaundice, back pain, nausea, weight loss, itching, and loss of appetite. Treatment depends upon the type of pancreatic cancer but may include surgery, chemotherapy, and/or radiation therapy.
Acute and Chronic Pancreatitis
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Celiac disease is a condition in which a person has inflammation of the small intestinal mucosa when exposed to gluten in the diet. Symptoms of celiac disease include bloating, nausea, diarrhea, and abdominal discomfort. Treatment is a gluten free diet. Some individuals may have refractory celiac disease in which they do not respond to a gluten free diet.
Pancreas divisum is a common congenital anomaly (an anomaly that is present at birth) of the pancreatic duct(s). The human embryo starts life with two ducts in the pancreas; the ventral duct and the dorsal duct. In more than 90% of the embryos, the dorsal and the ventral ducts will fuse to form one main pancreatic duct. In approximately 10% of embryos, the dorsal and the ventral ducts fail to fuse. Failure of the ventral and the dorsal pancreatic ducts to fuse is called pancreas divisum (because the pancreas is drained by two ducts). In pancreas divisum, the ventral duct drains into the major papilla, while the dorsal duct drains into a separate minor papilla. The majority of individuals born with pancreas divisum experience no symptoms throughout life, will remain undiagnosed and will not require treatment. A small number of patients with pancreas divisum will experience repeated episodes of pancreatitis.
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Cramps but No Period
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