Exploring Your Options: Is there an alternative to Zenpep?

October 10, 2025 •

4 min read

Approximately 1.2 million people in the US were prescribed Zenpep in 2020, but not everyone responds well or finds it affordable. Fortunately, there are several effective prescription and non-prescription options if you need an alternative to Zenpep.

Quick Summary

FDA-approved alternatives for pancreatic enzyme replacement therapy include Creon, Pancreaze, Pertzye, and Viokace, which offer various formulations and dosages.

Key Points

Prescription alternatives exist: FDA-approved pancreatic enzyme products like Creon, Pancreaze, Pertzye, and Viokace are effective prescription alternatives to Zenpep for treating EPI.
Not a 1:1 swap: PERT products are not interchangeable due to differing enzyme content and delivery systems. Any switch requires medical supervision and dosage adjustment.
Viokace has unique administration: Viokace is a non-enteric-coated tablet and requires co-administration with an acid-reducing agent like a PPI to be effective.
OTC enzymes are not recommended for true EPI: Over-the-counter pancreatic enzymes lack FDA regulation, have inconsistent potency, and often lack the enteric coating needed to survive stomach acid, making them an unreliable treatment for EPI.
Compare formulations and strengths: When considering alternatives, compare the specific formulations and available lipase unit strengths of each product with your doctor to find the best match for your digestive needs.
Cost and insurance vary: The cost of PERT products can vary significantly based on insurance coverage and pharmacy, so comparing options can be beneficial.
Monitor your response: After switching to a new PERT, it is important to monitor your symptoms closely, as it can take time to adjust to a new product.

Understanding Pancreatic Enzyme Replacement Therapy (PERT)

Zenpep is a brand-name medication containing pancrelipase, a combination of digestive enzymes including lipase, amylase, and protease. It is prescribed for a condition called exocrine pancreatic insufficiency (EPI), where the pancreas does not produce enough enzymes to properly digest food. This can result from conditions like cystic fibrosis, chronic pancreatitis, or pancreatic cancer. The resulting malabsorption can cause symptoms such as fatty stools (steatorrhea), diarrhea, bloating, and weight loss. While effective, reasons to seek an alternative to Zenpep can include side effects, cost, or insurance coverage. It is crucial to remember that any change in medication should only occur under the supervision of a healthcare professional, as all prescribed Pancreatic Enzyme Products (PEPs) are considered non-interchangeable by the FDA due to differences in formulation.

FDA-Approved Prescription Alternatives

Several FDA-approved pancreatic enzyme products are available on the market that can serve as an effective alternative to Zenpep. All of these products are derived from porcine (pig) sources and contain the same active ingredients—pancrelipase (a mixture of lipase, protease, and amylase)—but differ in their manufacturing, coating, and available strengths.

Creon: One of the most widely known PERT products, Creon consists of enteric-coated microspheres within a capsule. The enteric coating protects the enzymes from stomach acid, allowing them to be released in the small intestine where they are most effective. Creon is available in a wide range of lipase unit strengths.
Pancreaze: This alternative also uses enteric-coated microtablets to protect the enzymes. It is available in five different lipase strengths to accommodate patient needs.
Pertzye: Pertzye, like Creon, uses enteric-coated microspheres and is available in multiple lipase strengths.
Viokace: Viokace is a unique alternative as it is a non-enteric-coated tablet. Because it lacks the protective coating, it must be taken alongside a proton pump inhibitor (PPI), which reduces stomach acid to prevent the enzymes from being deactivated. This makes Viokace a specialized option that requires careful medical management.

Over-the-Counter (OTC) and Non-Standardized Options

For individuals with genuine EPI, over-the-counter pancreatic enzyme supplements are not a recommended alternative. Here's why:

Lack of FDA Regulation: OTC enzymes are classified as dietary supplements, meaning they are not subject to the same rigorous FDA testing for consistency and efficacy as prescription medications. Their labeled enzyme activity may not reflect the true content.
Inconsistent Potency: The enzyme potency in OTC products can vary widely, making it difficult to achieve the stable, effective dosing needed to manage EPI symptoms properly.
Ineffective Delivery: Many OTC enzymes lack the crucial enteric coating that protects them from being destroyed by stomach acid, rendering them largely ineffective for someone with true pancreatic insufficiency.
Fungal-Based Enzymes: Some OTC products use fungal-based enzymes as an alternative to the porcine-derived versions used in prescription PERT. While potentially an option for those with dietary or religious restrictions, their efficacy is unproven for clinical EPI.

Important Considerations for Switching Medications

Switching from Zenpep to another PERT product is not a simple one-to-one conversion and must be managed by a healthcare provider.

Dosing Based on Lipase Units: When transitioning to a new PERT, the doctor will calculate a new dose based on the lipase units in the new medication, as the concentration can vary.
Dosage Titration: It can take up to two weeks for a patient to adjust to a new PERT dose, so careful monitoring is necessary to ensure symptom control.
Monitoring for Effectiveness: A healthcare provider will monitor key indicators after a switch to confirm the new medication is working. These include the reduction of gastrointestinal symptoms (like bloating and diarrhea), weight stability, and improvement in nutrient levels.

Zenpep vs. Other PERT Products: A Comparison


Feature	Zenpep	Creon	Pancreaze	Pertzye	Viokace	OTC Enzymes
Formulation	Enteric-coated microspheres in a capsule	Enteric-coated microspheres in a capsule	Enteric-coated microtablets in a capsule	Enteric-coated microspheres in a capsule	Non-enteric-coated tablets	Various (may or may not be coated)
Active Ingredient	Pancrelipase (porcine)	Pancrelipase (porcine)	Pancrelipase (porcine)	Pancrelipase (porcine)	Pancrelipase (porcine)	Varies (porcine, fungal, plant)
Available Strengths	Multiple lipase unit strengths	Multiple lipase unit strengths	Multiple lipase unit strengths	Multiple lipase unit strengths	Two lipase unit strengths	Inconsistent, variable potency
Requires PPI?	No	No	No	No	Yes	N/A
FDA Approved?	Yes	Yes	Yes	Yes	Yes	No (classified as supplement)
Cost	Varies by insurance and location	Varies by insurance and location (may be more expensive)	Varies by insurance and location	Varies by insurance and location	Varies by insurance and location	Less expensive upfront, unreliable efficacy

Conclusion: Finding the Right Alternative for Your Needs

Zenpep is a highly effective medication for treating EPI, but it is not the only option available. For patients needing an alternative to Zenpep due to cost, side effects, or a preference for a different formulation, other FDA-approved PERT products like Creon, Pancreaze, Pertzye, and Viokace are proven to be safe and effective. Non-prescription over-the-counter enzymes are not a recommended substitute due to a lack of regulation and inconsistent potency. The decision to switch medications should always be made in consultation with a healthcare provider who can guide the change, adjust the dosage based on your specific needs, and ensure ongoing symptom control. By understanding the available alternatives, patients can work with their doctor to find the best treatment plan. You can find more information about pancreatic enzyme replacement therapy on the National Institutes of Health website.

Frequently Asked Questions

No, you should not switch medications without guidance from a healthcare provider. While other FDA-approved pancrelipase products like Creon and Pancreaze are available, they are not interchangeable due to differences in formulation and enzyme concentration. Your doctor must determine the correct equivalent dose for the new product.

No. Over-the-counter pancreatic enzymes are not regulated by the FDA and lack the reliable potency and proper enteric coating of prescription medications. This makes them largely ineffective and unsafe for treating clinical Exocrine Pancreatic Insufficiency (EPI).

Both Zenpep and Creon contain pancrelipase with enteric-coated microspheres. The key differences lie in their available dosage strengths and specific formulation. Some patients may also respond differently to each product, and costs can vary based on insurance coverage.

Viokace is a non-enteric-coated tablet, which means it requires co-administration with a proton pump inhibitor (PPI) to prevent stomach acid from destroying the enzymes before they can work. This differs from other alternatives that are already enteric-coated.

Doctors will calculate the equivalent dosage based on the lipase units in the new PERT product. The optimal dose is typically determined by the patient's weight, with adjustments made based on symptom response.

Reasons to seek an alternative can include high cost, poor insurance coverage, undesirable side effects, or ineffective symptom control from Zenpep.

While a low-fat diet is often recommended to manage symptoms of EPI, and certain herbs may help with general digestion, they cannot replace the concentrated enzyme formulations provided by prescription PERT medications. You should always consult a doctor before taking any supplements for a medical condition.