PERT Side Effects: Complete Guide

Common Side Effects

These side effects occur in more than 1% of patients taking PERT. Most are mild and often improve within the first few weeks of treatment.

Digestive System

•Stomach pain/discomfort - Usually mild, improves with time
•Bloating or gas - May indicate dose needs adjustment
•Nausea - Taking with food helps
•Diarrhea or constipation - Usually temporary

Other Common Effects

•Headache - Occurs in ~6% of patients
•Dizziness - Usually mild and temporary
•Cough - More common in some formulations
•Sore throat - May occur with certain brands

Good News About Common Side Effects

Studies show that most common side effects are dose-related and temporary. In clinical trials, the rate of side effects in patients taking PERT was often similar to those taking placebo, suggesting many digestive symptoms may be related to underlying EPI rather than the enzymes themselves.

Less Common Side Effects

These occur in less than 1% of patients but are worth knowing about:

Side Effect	Frequency	What to Do
Mouth or lip irritation	Uncommon	Don't chew capsules; rinse mouth after sprinkling
Skin rash or itching	Rare	Contact doctor; may indicate allergy
Joint pain	Rare	Monitor and report to doctor
Elevated uric acid	Rare	May be monitored in patients with gout history

Serious Side Effects (Rare)

Seek Immediate Medical Attention For:

Severe allergic reaction: Difficulty breathing, swelling of face/throat, severe rash, hives
Severe abdominal pain: Especially if accompanied by vomiting or bloating
Blood in stool or black, tarry stools
Signs of gout: Sudden joint pain, swelling, warmth (especially in big toe)

About Fibrosing Colonopathy

Fibrosing colonopathy is a rare but serious condition associated with very high doses of pancreatic enzymes, primarily reported in children with cystic fibrosis. It involves scarring and narrowing of the large intestine.

Prevention:

• Don't exceed 10,000 lipase units per kg body weight per day
• Or 2,500 lipase units per kg per meal
• Work with your doctor to find the lowest effective dose
• Report any new or worsening abdominal symptoms promptly

Managing Side Effects

For Stomach Discomfort

Take enzymes with the first bite of food, not before
Split doses throughout longer meals
Ask your doctor about adding a proton pump inhibitor (PPI)

For Mouth Irritation

Never chew or crush enzyme capsules
If sprinkling on food, swallow immediately without holding in mouth
Rinse mouth with water after taking enzymes

For Ongoing Symptoms

Track symptoms with our Symptom Tracker
Your doctor may adjust your dose or try a different brand
Consider dietary adjustments alongside enzyme therapy

When to Contact Your Doctor

Schedule an Appointment If:

• Side effects persist beyond 2-3 weeks
• Symptoms worsen instead of improving
• You notice new or unusual symptoms
• Your weight continues to drop
• Steatorrhea (oily stools) doesn't improve

Seek Immediate Care If:

• Severe abdominal pain or cramping
• Difficulty breathing or swallowing
• Severe skin reaction or hives
• Blood in stool or vomit
• Signs of severe dehydration

Drug Interactions

PERT can interact with certain medications. Always inform your healthcare providers about all medications you take.

Medication Type	Interaction	Recommendation
Antacids (calcium/magnesium)	May reduce enzyme effectiveness	Separate doses by 2 hours
Iron supplements	Enzymes may affect iron absorption	Monitor iron levels; may need adjustment
Acarbose (diabetes med)	Enzymes may reduce acarbose effects	Monitor blood sugar; discuss with doctor

This is not a complete list. Always check with your pharmacist or doctor about potential interactions.

PERT Side Effects: What to Expect

Key Takeaway