Prescription and OTC options: What can I take instead of ZENPEP?

Approximately 80% to 90% of people with cystic fibrosis require pancreatic enzyme replacement therapy (PERT) to aid digestion, and ZENPEP is just one of several FDA-approved options. For various reasons, patients may need to find out what can I take instead of ZENPEP, and several prescription and over-the-counter alternatives are available to consider.

Quick Summary

Several prescription alternatives exist for ZENPEP, including Creon, Pancreaze, Pertzye, and Viokace. These products differ in formulation and enzyme concentration, and require a doctor's guidance when switching. Over-the-counter options are generally not recommended due to different manufacturing standards and lower efficacy. Dietary modifications are also a crucial part of managing exocrine pancreatic insufficiency.

Key Points

• Prescription alternatives: FDA-approved PERT alternatives to ZENPEP include Creon, Pancreaze, Pertzye, and Viokace.

• Not interchangeable: Do not switch between PERT brands without medical supervision, as formulations and potency can differ.

• OTC supplements are inadequate: Over-the-counter enzymes lack FDA regulation, have significantly lower lipase activity, and often lack the necessary enteric coating found in prescription products.

• Viokace requires an acid-reducer: Unlike the other enteric-coated PERTs, the tablet form of Viokace must be taken with an acid-reducing agent.

• Consult your doctor for a switch: Your healthcare provider will determine the appropriate new dosage based on lipase units and monitor your response after switching.

• Dietary management is crucial: Following a low-fat diet and avoiding alcohol and smoking are important parts of managing EPI.

• Cost varies: Insurance coverage can significantly affect the cost of PERT, so checking your plan is essential.

Understanding Pancreatic Enzyme Replacement Therapy (PERT)

ZENPEP is a brand name for pancrelipase, a combination of digestive enzymes (lipase, protease, and amylase) derived from porcine (pig) pancreatic glands. It is a form of Pancreatic Enzyme Replacement Therapy (PERT) used to treat exocrine pancreatic insufficiency (EPI), a condition where the pancreas does not produce enough enzymes to properly digest food. Conditions like cystic fibrosis, chronic pancreatitis, and pancreatic cancer can cause EPI. When considering alternatives, it is important to remember that all FDA-approved prescription PERT products contain these same key enzymes but differ in formulation and dosage strengths. This is why they are not interchangeable without a doctor's oversight.

Prescription alternatives to ZENPEP

Several other FDA-approved prescription PERT medications are available and can be used as alternatives to ZENPEP.

• Creon (pancrelipase): One of the most widely known PERT products, Creon consists of enteric-coated microspheres designed to protect the enzymes from stomach acid. It is indicated for treating EPI in conditions like cystic fibrosis, chronic pancreatitis, and pancreatectomy.
• Pancreaze (pancrelipase): This product is made up of enteric-coated microtablets and is also used for EPI associated with cystic fibrosis and other conditions.
• Pertzye (pancrelipase): Pertzye is another porcine-derived PERT consisting of enteric-coated microspheres. It is approved for EPI due to cystic fibrosis and other pancreatic conditions.
• Viokace (pancrelipase): Unlike the other options, Viokace is a non-enteric-coated tablet and therefore must be taken with an acid-reducing agent, such as a proton pump inhibitor (PPI), to protect the enzymes from gastric acid. It is also indicated for EPI in adults with chronic pancreatitis or pancreatectomy.

Important considerations when switching

Before switching from ZENPEP, it is crucial to consult your healthcare provider. They will evaluate your specific condition, dosage needs, and potential tolerability differences between products.

• Dosage equivalence: When changing products, your doctor will match the lipase units as closely as possible, but dosage adjustments over a few weeks may be necessary to find the optimal dose.
• Formulation and tolerability: While the active ingredients are similar, the specific formulation (microspheres vs. microtablets) can affect absorption and how well your body tolerates the medication. Some patients may respond differently to one brand over another.
• Insurance coverage and cost: The cost of PERT can vary significantly based on your insurance plan and whether it's the preferred product. Your doctor can help navigate prior authorizations or explore patient assistance programs if needed.

Over-the-counter (OTC) supplements

Many OTC digestive enzyme supplements are available, but experts and major medical organizations strongly advise against using them as a replacement for prescription PERT.

• Lack of FDA regulation: Unlike prescription PERT, OTC supplements are not subject to the same rigorous FDA regulation for potency, quality, and efficacy. The amount of active enzyme can vary widely between products.
• Inactive lipase: Lipase is the most important enzyme for EPI patients, but the lipase content in OTC products is significantly less active than in prescription versions.
• Lack of enteric coating: Most OTC porcine-based enzymes lack a protective enteric coating, meaning they will be destroyed by stomach acid before they can reach the intestine and be effective.
• Fungal-based alternatives: Some OTC supplements use fungal-derived enzymes, which are animal-free, but may require a much higher dosage to be effective and are not FDA-regulated for this purpose.

Comparison of Prescription Pancrelipase Products

Feature	ZENPEP	Creon	Pancreaze	Pertzye	Viokace
Formulation	Enteric-coated microspheres	Enteric-coated microspheres	Enteric-coated microtablets	Enteric-coated microspheres	Non-enteric-coated tablets
Lipase Units	3K to 40K	3K to 36K	2.6K to 37K	4K to 24K	10.44K and 20.88K
Requires Acid-Reducer?	No	No	No	No	Yes (typically PPI)
Usage	Take with meals/snacks	Take with meals/snacks	Take with meals/snacks	Take with meals/snacks	Take with meals/snacks
Opening Capsules	Yes, can sprinkle on acidic food	Yes, can sprinkle on acidic food	Yes, can sprinkle on acidic food	Yes, can sprinkle on acidic food	No (tablet)

Non-pharmacological management for EPI

While medication is central to treating EPI, certain lifestyle and dietary adjustments can also improve digestion and nutrient absorption.

• Follow a recommended diet: Your doctor or nutritionist will likely recommend a diet tailored to your needs. This often involves a low-fat diet, as fats are the most difficult to digest without adequate pancreatic enzymes.
• Avoid alcohol and smoking: Both alcohol and smoking can further irritate the pancreas, worsening your underlying condition.
• Maintain adequate hydration: Ensuring you drink plenty of water is essential, particularly when taking enzymes.
• Smaller, more frequent meals: Some individuals with EPI find that eating smaller, more frequent meals throughout the day can aid digestion and reduce symptoms.

Conclusion

For those seeking alternatives to ZENPEP, several FDA-approved prescription PERT products exist, including Creon, Pancreaze, Pertzye, and Viokace. These products have similar therapeutic effects but differ in formulation, dosage strengths, and insurance coverage. It is critical to work with your healthcare provider to switch medications, as PERT products are not interchangeable and dosage adjustments may be needed. Over-the-counter supplements are generally not adequate replacements due to a lack of regulation and lower enzyme potency. In addition to medication, dietary modifications and lifestyle changes are key components of effective EPI management.

For more detailed information on pancreatic enzyme therapy, consult resources from authoritative organizations like the National Center for Biotechnology Information (NCBI).

Frequently Asked Questions

Are there any generic versions of ZENPEP?

There are currently no generic versions of ZENPEP or other FDA-approved pancrelipase products available on the market. All approved PERT products are considered brand-name and are derived from porcine enzymes.

Can I use an over-the-counter enzyme supplement instead of ZENPEP?

No, over-the-counter (OTC) supplements are not suitable alternatives to prescription ZENPEP. OTC products are not FDA-regulated for efficacy, have much lower active lipase content, and often lack the enteric coating needed to survive stomach acid.

Why can't I just switch to another prescription pancrelipase product on my own?

You should never switch between prescription pancrelipase products without a doctor's guidance. The different brands, while containing the same enzymes, vary in their formulation, enzyme concentration, and release mechanisms, meaning they are not interchangeable.

What happens if I forget a dose of my pancrelipase?

If you miss a dose of your pancrelipase, you should skip the missed dose and take your next dose with your next meal or snack. Do not take a double dose to make up for a missed one.

How should I take my pancrelipase medication?

You should take pancrelipase capsules with plenty of water at the beginning of every meal and snack. If you have trouble swallowing, you can open the capsule and sprinkle the contents onto a small amount of acidic food like applesauce.

What side effects should I watch for when taking pancrelipase?

Common side effects include stomach pain, headaches, gas, and changes in bowel movements. Serious but rare side effects can include allergic reactions and fibrosing colonopathy, a bowel disorder. Report any severe or unusual side effects to your doctor immediately.

Is there a non-pork alternative to ZENPEP?

All current FDA-approved PERT products, including ZENPEP, are derived from porcine pancreatic tissue. While some over-the-counter fungal-based enzymes exist, they are not regulated and are not a reliable replacement for prescription PERT.