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:

1. Proteases for digesting proteins
2. Lipases for digesting fats
3. Amylases for digesting carbohydrates

These digestive enzymes are available in pancreatic enzyme products (PEPs).

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:

• Celiac disease
• Crohn's disease
• Certain cases of poor digestion are associated with deficiencies in pancreatic 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
• Itching
• Red, swollen, blistered, or peeling skin
• Wheezing

Other side effects of digestive enzymes include:

• Stomach pain
• Headache
• Gas
• Constipation
• Cough
• Sore throat
• Diarrhea
• Upset stomach
• Nausea or vomiting
• Neck pain
• Stuffy nose
• Heartburn
• Ear pain
• Dizziness
• Nosebleed

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

• Stomach pain
• Constipation
• Upset stomach
• Vomiting
• Diarrhea

Many digestive enzymes are derived from pork and therefore, should not be used by patients who are allergic to pork.

• 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.

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.

1. Pancreatin (Ku-Zyme, Kutrase, Lapase)
2. Pancrelipase (Cotazym S, Creon
3. Creon (Lipase 24,000 unit)
4. Creon (Lipase 3,000 unit)
5. Creon (Lipase 12,000 unit)
6. Creon (Lipase 6,000 unit)
7. Creon 10
8. Creon 20
9. Creon 5
10. Dygase
11. Ku-Zyme HP
12. Lipram
13. Lipram 10,000
14. Palcaps-10
15. Palcaps-20
16. Pancrease
17. Pancrease MT 10
18. Pancrease MT 16
19. Pancrease MT 20
20. Pancrease MT 4
21. Pancreaze
22. Pancrecarb MS-16
23. Pancrecarb MS-4
24. Pancrecarb MS-8
25. Pancron 10
26. Pancron 20
27. Pangestyme CN 10
28. Pangestyme CN 20
29. Pangestyme EC
30. Pangestyme MT16
31. Pangestyme UL12
32. Pangestyme UL18
33. Pangestyme UL20
34. Panocaps
35. Panocaps MT-16
36. Panocaps MT-20
37. Panokase
38. Panokase 16
39. PERTZYME
40. Plaretase
41. Ultracaps MT-20
42. Ultrase
43. Ultrase MT 12
44. Ultrase MT 18
45. Ultrase MT20
46. Ultresa
47. Viokace
48. Viokase
49. Zenpep,
50. Zenpep (Lipase 10,000 unit)
51. Zenpep (Lipase 15,000 unit)
52. Zenpep (Lipase 20,000 unit)
53. Zenpep (Lipase 25,000 unit)
54. Zenpep (Lipase 3,000 unit)
55. Zenpep (Lipase 5,000 unit)

• 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.

• 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.