Immediate steps when Creon is unavailable
When your pharmacy informs you that your Creon prescription is not available, it's important to act quickly and follow a clear plan to prevent a gap in your treatment. Your primary point of contact should be your healthcare team and pharmacist.
Contact your pharmacy and healthcare provider
- Communicate with your pharmacy: Ask your pharmacist to check with their wholesalers for updated stock. They may have specific information about when the next supply is expected. Many pharmacies are regularly restocking, so checking back in a few days can be productive.
- Talk to your doctor: Contact your prescribing physician or the specialist who manages your condition (such as a CF team). They are the only ones who can write a new prescription for an alternative pancreatic enzyme replacement therapy (PERT).
Consider other pharmacies
- Call other local pharmacies: Don't rely on a single pharmacy. Different chains and independent pharmacies might have different stock levels. Try calling several in your area to see if they have your specific dose or any alternatives in stock.
- Centralized ordering: Some hospital teams or patient support organizations can order directly from distributors during a shortage. Your care team can advise if this is an option for you.
Prioritize your prescription
- Request separate prescriptions: Ask your doctor for a separate prescription for your PERT. This makes it easier to try different pharmacies without waiting for an entire repeat prescription.
Prescription alternatives and switching PERTs
Several other FDA-approved PERT products are available that contain pancrelipase, the same active ingredient as Creon. However, these are not directly interchangeable, and switching requires a new prescription and medical guidance.
Matching lipase units
When switching from Creon, your doctor will prescribe an alternative brand and dosage that provides a similar amount of lipase units. This is the most crucial part of matching therapies, as the dose is standardized by lipase content. It's essential to follow your doctor's instructions precisely, as dosage adjustments may be needed over time based on your symptoms.
Comparison of FDA-approved PERT products
| Feature | Creon | Zenpep | Pancreaze | Pertzye | Viokace |
|---|---|---|---|---|---|
| Active Ingredient | Pancrelipase | Pancrelipase | Pancrelipase | Pancrelipase | Pancrelipase |
| Source | Porcine | Porcine | Porcine | Porcine | Porcine |
| Coating | Enteric-coated microspheres | Enteric-coated microspheres | Enteric-coated microtablets | Enteric-coated microspheres | Uncoated tablets |
| Requires PPI? | No | No | No | No | Yes |
| Key Differences | Widely used; standard | Effective alternative; wide dose range | Effective alternative | Effective alternative | Requires co-administration with a proton pump inhibitor (PPI) |
Managing symptoms with dietary and lifestyle adjustments
If there is a delay in obtaining any PERT, your doctor may suggest short-term dietary adjustments to minimize symptoms like bloating, diarrhea, and abdominal pain.
Dietary strategies
- Reduce fat intake: As fat is the most difficult nutrient for the body to digest without sufficient enzymes, temporarily reducing your fat intake can help manage gastrointestinal symptoms. However, do not cut out fat completely without medical advice, as this is critical for absorbing fat-soluble vitamins (A, D, E, K).
- Eat smaller, more frequent meals: This can make digestion easier and less overwhelming for your system.
- Consider low-fat or peptide-based nutritional supplements: For patients experiencing significant weight loss or severe symptoms, peptide-based oral nutritional supplements can be a temporary solution under a doctor's guidance. Unlike standard supplements, these require minimal or no enzymes for absorption.
- Modify mealtime habits: Spreading your enzyme dose throughout the meal, rather than taking it all at once, can maximize its effectiveness.
Supplementation and other considerations
- Avoid alcohol and smoking: These can exacerbate pancreatic issues and should be avoided.
- Stay hydrated: Drinking plenty of water is important when taking enzymes.
- Be aware of medication interactions: If you are temporarily without PERT, some medications may be less effective. Consult your doctor if you take medication for blood clots, seizures, or oral contraceptives.
Long-term management and safety
Managing pancreatic insufficiency is a lifelong commitment. While shortages are often temporary, having a plan in place is essential for your long-term health.
The risks of untreated EPI
Without proper enzyme replacement, the inability to absorb nutrients can lead to malnutrition, weight loss, osteoporosis, and vitamin deficiencies. Do not attempt to self-medicate or significantly alter your diet without consulting a healthcare professional.
Over-the-counter (OTC) supplements
While OTC pancreatic enzyme supplements are available, their quality and potency can vary widely. Unlike prescription PERTs, they are not regulated by the FDA and their effectiveness for treating exocrine pancreatic insufficiency is not proven. Always discuss OTC options with your doctor before use.
Conclusion
Finding yourself unable to get your Creon prescription is a serious and stressful situation. The key is to stay calm, communicate with your healthcare team, and follow a systematic approach. By exploring prescription alternatives like Zenpep or Pancreaze, making temporary dietary adjustments, and coordinating with your pharmacist and doctor, you can effectively manage your condition and ensure your nutritional needs are met. Always remember that your healthcare provider is your best resource for navigating medication shortages and ensuring you receive the appropriate treatment.
Optional outbound link
For more information on managing pancreatic enzyme replacement therapy, you can visit the Pancreatic Cancer Action Network's guide: Pancreatic enzyme replacement therapy (PERT)
