Pancreatic enzyme pharmacotherapy.
Supplemental pancreatic enzyme preparations are provided to patients with conditions of pancreatic exocrine deficiency such as chronic pancreatitis and cystic fibrosis. These patients frequently experience steatorrhea, which occurs from inadequate fat absorption. The delivery of sufficient enzyme concentrations into the duodenal lumen simultaneously with meals can reduce nutrient malabsorption, improve the symptoms of steatorrhea, and in some cases alleviate the pain associated with chronic pancreatitis. Current clinical practices dictate administration of lipase 25,000-40,000 units/meal by using pH-sensitive pancrelipase microspheres, along with dosage increases, compliance checks, and differential diagnosis in cases of treatment failure. Despite the large number of specialty enzyme replacements available commercially, many patients remain dissatisfied with standard therapy, and future developments are needed to optimize treatment in these individuals.
Ferrone
Marcus
M
Department of Clinical Pharmacy, Drug Product Services Laboratory, University of California, San Francisco, California 94118-0613, USA. Ferronem@pharmacy.ucsf.edu
Raimondo
Massimo
M
Scolapio
James S
JS
D003550:Cystic Fibrosis / Q000188:drug therapy; D004063:Digestion / Q000502:physiology; D010188:Exocrine Pancreatic Insufficiency / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D010146:Pain / Q000188:drug therapy; D010179:Pancreas / Q000201:enzymology / Q000378:metabolism; D010194:Pancreatin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010195:Pancreatitis / Q000188:drug therapy; D020799:Pancrelipase / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D005765:Gastrointestinal Agents; D020799:Pancrelipase; D010194:Pancreatin