You deserve to feel normal again. If you've been struggling with enzyme dosing, confused about when and how much to take, or frustrated that PERT isn't working as well as it should—you're not alone. Mastering your treatment plan is achievable with the right guidance.
Understanding EPI Treatment
The primary treatment for EPI is Pancreatic Enzyme Replacement Therapy (PERT). Since your pancreas cannot produce enough digestive enzymes, PERT supplements what's missing, allowing your body to properly digest and absorb nutrients from food.
With proper treatment, most people with EPI can maintain good nutrition, gain weight if needed, and significantly improve their quality of life. The key is finding the right enzyme dose and timing for your individual needs.
Pancreatic Enzyme Replacement Therapy (PERT)
What is PERT?
PERT consists of capsules containing digestive enzymes (lipase, protease, and amylase) derived from porcine (pig) pancreatic tissue. These enzymes are enteric-coated, meaning they're designed to survive stomach acid and release in the small intestine where digestion occurs.
FDA-Approved PERT Medications
Creon
Most PrescribedAvailable strengths: 3,000, 6,000, 12,000, 24,000, 36,000 lipase units
Delayed-release capsules with enteric-coated beads
Zenpep
Available strengths: 3,000, 5,000, 10,000, 15,000, 20,000, 25,000, 40,000 lipase units
Delayed-release capsules
Pancreaze
Available strengths: 4,200, 10,500, 16,800, 21,000 lipase units
Delayed-release capsules with bicarbonate buffer
Pertzye & Viokace
Additional options available with different formulations and strengths
Calculate Your Perfect PERT Dose
Finding the right enzyme dose is crucial but complex. Our guide includes PERT dosing calculators, meal-specific recommendations, and adjustment strategies to help you optimize your treatment.
Master Your PERT StrategyHow to Take PERT Effectively
Dosing Guidelines
- • Starting dose: Typically 40,000-50,000 lipase units per meal
- • Snacks: Half the meal dose (20,000-25,000 units)
- • Timing: Take at the beginning of each meal or snack
- • Swallow whole: Don't crush or chew capsules
- • Distribution: Split dose – take half at start, half midway through meal
Important Tips
- • Never take enzymes without food
- • Match dose to fat content of meal (higher fat = more enzymes)
- • If you can't swallow capsules, open them and mix beads with acidic food (applesauce)
- • Don't hold enzymes in your mouth – can cause mouth irritation
- • Drink plenty of water with enzymes
Adjusting Your PERT Dose
Finding the right dose is highly individual. Work with your doctor to adjust based on:
Signs Dose is Too Low
- • Continued steatorrhea (fatty stools)
- • Ongoing weight loss
- • Persistent bloating and gas
- • Abdominal discomfort after meals
Signs Dose is Right
- • Normal-appearing stools
- • Weight stabilization or gain
- • Reduced bloating and gas
- • Improved energy levels
Maximum Daily Dose
FDA recommends not exceeding 10,000 lipase units per kg of body weight per day or 4,000 lipase units per gram of fat consumed per day due to risk of fibrosing colonopathy (rare intestinal complication).
Troubleshoot PERT Problems Like a Pro
Not getting the results you expected? Learn how to identify and solve common PERT challenges, from timing issues to brand selection, with our comprehensive troubleshooting guide.
Get Complete Treatment GuidePotential Side Effects & Management
Common Side Effects (Generally Mild)
- • Nausea • Stomach pain • Diarrhea or constipation • Gas • Headache
Serious Side Effects (Seek Medical Attention)
- • Severe abdominal pain • Allergic reactions • Difficulty breathing • Joint pain
Complementary Treatments
Proton Pump Inhibitors (PPIs)
Medications like omeprazole reduce stomach acid, helping pancreatic enzymes work better.
Often prescribed alongside PERT for optimal enzyme function.
Fat-Soluble Vitamin Supplements
Vitamins A, D, E, K in water-soluble forms for better absorption.
Medium-Chain Triglycerides (MCT Oil)
Special fats that don't require pancreatic enzymes for absorption. Can supplement calorie intake.
Master Your EPI Treatment Plan
Our complete guide includes PERT dosing calculators, symptom tracking tools, and strategies for working effectively with your healthcare team.
Get the Complete Guide