What medication is used for intestinal enzymes? A Guide to Pancrelipase

October 8, 2025 •

4 min read

According to the National Institute of Diabetes and Digestive and Kidney Diseases, exocrine pancreatic insufficiency (EPI) is a condition where the pancreas fails to produce enough digestive enzymes, leading to malabsorption and symptoms such as bloating and weight loss. The primary answer to what medication is used for intestinal enzymes? is pancrelipase, a pancreatic enzyme replacement therapy (PERT) that helps restore proper digestion. This guide will provide a comprehensive overview of this vital treatment.

Quick Summary

Pancrelipase is the prescription medication used for intestinal enzyme replacement therapy to treat exocrine pancreatic insufficiency. It helps the body digest fats, proteins, and carbohydrates when the pancreas is unable to produce sufficient enzymes.

Key Points

Pancrelipase is the primary medication: Prescription pancrelipase, known as Pancreatic Enzyme Replacement Therapy (PERT), is used to treat exocrine pancreatic insufficiency (EPI).
Replenishes digestive enzymes: The medication provides lipase, protease, and amylase, which are essential for breaking down fats, proteins, and carbohydrates in food.
Treats conditions like cystic fibrosis: PERT is critical for managing EPI caused by conditions such as cystic fibrosis, chronic pancreatitis, and pancreatic surgery.
Requires precise timing with meals: The medication must be taken with the first bite of meals and snacks to effectively aid digestion.
Comes in various brands: Popular FDA-approved brands include Creon, Zenpep, Pancreaze, Pertzye, and Viokace, with differences in formulation and indication.
OTC supplements are not sufficient: Over-the-counter enzyme products are not regulated and lack the potency and consistency required to properly treat EPI.
Correct administration is key: To prevent enzyme destruction and mouth irritation, enteric-coated capsules must be swallowed whole.
Dosage is highly individualized: The amount of medication is based on body weight, diet, and symptoms, and must be determined and adjusted by a healthcare provider.
Most side effects are gastrointestinal: Common side effects include abdominal pain, bloating, and diarrhea, though these often improve with proper administration.

Pancrelipase: The Core Medication for Enzyme Replacement

When the body's pancreas does not release enough digestive enzymes into the small intestine, a condition known as exocrine pancreatic insufficiency (EPI) occurs. This can happen due to underlying diseases such as cystic fibrosis, chronic pancreatitis, or after pancreatic surgery. The standard medical treatment for this deficiency is Pancreatic Enzyme Replacement Therapy (PERT), with the key active ingredient being pancrelipase.

Pancrelipase is a prescription medication derived from pig pancreases that contains a mixture of the three main digestive enzymes:

Lipase: Helps the body break down and absorb fats.
Protease: Aids in the digestion of proteins.
Amylase: Assists with breaking down carbohydrates and starches.

By replacing these missing enzymes, pancrelipase significantly improves nutrient absorption and helps alleviate the gastrointestinal symptoms associated with EPI, such as bloating, diarrhea, and fatty stools (steatorrhea).

Popular Prescription Pancrelipase Brands

Several FDA-approved pancrelipase products are available by prescription, each with varying strengths and formulations. The most common brands include:

Creon®: One of the most widely prescribed PERT treatments, available in delayed-release capsules that contain enteric-coated microspheres.
Zenpep®: A popular alternative to Creon, also provided in delayed-release capsules with enteric-coated beads to protect enzymes from stomach acid.
Pancreaze®: Features enteric-coated microtablets within a capsule.
Pertzye®: Another delayed-release capsule option for EPI treatment.
Viokace®: Unlike other brands, this is an immediate-release tablet that is not enteric-coated. It must be taken in combination with a proton pump inhibitor (PPI) to protect the enzymes from stomach acid.

Since these products are not interchangeable, it is crucial for patients to stick with the specific brand prescribed by their healthcare provider.

Comparison: Prescription PERT vs. OTC Enzymes

While over-the-counter (OTC) digestive enzyme supplements are widely available, they differ significantly from prescription-strength pancrelipase. This table highlights the key differences:


Feature	Prescription Pancrelipase (e.g., Creon, Zenpep)	Over-the-Counter (OTC) Enzymes
Source	Derived from pig pancreas, providing standardized lipase, protease, and amylase.	Varies widely; can be plant-based (fungal) or porcine, but quality is not standardized.
Regulation	FDA-approved and subject to rigorous safety and efficacy standards.	Not FDA-regulated for specific dosages or claims, leading to inconsistent potency and unpredictable results.
Potency	High and consistent enzyme activity, with potency often measured in standardized lipase units.	Often contains very low amounts of active enzymes or entirely lacks them.
Effectiveness	Clinically proven to be effective for managing EPI and improving nutrient absorption.	May offer mild symptomatic relief but is not an adequate replacement for the enzymes needed to treat EPI.
Protection	Enteric-coated capsules or concurrent PPI use protects enzymes from being destroyed by stomach acid.	May or may not have enteric coating, potentially rendering enzymes ineffective in the stomach.

How and When to Take Your Medication

For pancrelipase to be effective, proper timing and administration are essential. The goal is for the enzymes to be in the small intestine at the same time as food.

Take with meals and snacks: Always take pancrelipase with the first bite of food. For larger meals or for slower eaters, spreading the administration throughout the meal may be beneficial.
Swallow whole: Capsules should be swallowed whole with a sufficient amount of cold or room-temperature liquid. Avoid hot beverages, as high temperatures can damage the enzymes.
Do not crush or chew: Crushing or chewing the enteric-coated beads or microspheres can cause them to be destroyed by stomach acid and can also cause mouth irritation.
Alternative administration: If swallowing capsules is difficult, some can be opened and the contents mixed with a small amount of soft, acidic food, like applesauce. This mixture should be swallowed immediately without chewing.

Dosage and Side Effects

Pancrelipase dosage is highly individualized and determined by a healthcare provider based on factors like body weight, diet, and the severity of EPI symptoms.

Most patients tolerate pancrelipase well, and side effects are often mild. The most common side effects reported include:

Abdominal pain or cramping
Diarrhea or constipation
Gas or flatulence
Nausea
Headache

In rare cases, extremely high amounts of PERT have been associated with a serious bowel condition known as fibrosing colonopathy, especially in children with cystic fibrosis. It is crucial to adhere strictly to the prescribed administration and report any severe or unusual symptoms, such as significant abdominal pain or changes in bowel movements, to your doctor immediately.

Conclusion

For individuals with exocrine pancreatic insufficiency, pancrelipase is the essential prescription medication used for intestinal enzymes. It provides the crucial enzymes—lipase, protease, and amylase—needed for nutrient digestion and absorption. The effectiveness of this therapy depends on correct timing and administration, as well as finding the right individualized amount under a healthcare provider's supervision. While over-the-counter alternatives exist, they do not offer the same level of safety, standardization, or potency required for treating diagnosed EPI. Patients should always consult their doctor or a registered dietitian to ensure their treatment is optimized for their specific nutritional needs.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Please consult a qualified healthcare professional for any health concerns.

Frequently Asked Questions

The primary prescription medication for replacing intestinal enzymes is pancrelipase, which is a Pancreatic Enzyme Replacement Therapy (PERT).

Pancreatic enzyme replacement therapy (PERT) is needed for conditions that cause exocrine pancreatic insufficiency (EPI), most commonly cystic fibrosis, chronic pancreatitis, and pancreatic cancer or surgery.

Yes, there are several FDA-approved brands of pancrelipase, including Creon®, Zenpep®, Pancreaze®, Pertzye®, and Viokace®. These brands may have different formulations and indications.

No, over-the-counter digestive enzymes are not a suitable replacement for prescription pancrelipase. They are not regulated by the FDA for administration or claims and typically lack the potency required to treat EPI effectively.

Pancrelipase should be taken with the first bite of every meal and snack. Most formulations come in enteric-coated capsules that must be swallowed whole with a cold or room-temperature liquid. Do not crush or chew the capsules.

Common side effects include gastrointestinal issues like abdominal pain, bloating, constipation, or diarrhea. In rare cases, high amounts of the medication can lead to a serious bowel condition called fibrosing colonopathy.

The amount is highly individualized and determined by a healthcare provider. It is based on factors such as your body weight, diet, and the severity of your symptoms, and it is often adjusted over time.