Pancrelipase
Mucolytics and supportive cystic fibrosis therapies
Mucolytics and supportive cystic fibrosis therapies
Pig pancreas enzymes (lipase, protease, amylase) taken with meals when the pancreas cannot digest food, as in cystic fibrosis.
Also called: Pancreatic enzymes, Pancreatin (a weaker, older preparation)
Quick facts
- Group
- Mucolytics and supportive cystic fibrosis therapies
- Target
- Dietary fat, protein and starch in the small intestine (enzyme replacement)
- Used for
- Exocrine pancreatic insufficiency
- Key effects
- Abdominal pain · Nausea · Headache
- Monitor
- Stool pattern · Weight · Uric acid when there is gout
- ATC
- A09AA02
No doses: the clinician sets them by the current guideline.
Mechanism of action
Pancrelipase is a purified mixture of porcine pancreatic enzymes: lipase, proteases and amylase. Taken with food, it does the work of the missing exocrine pancreas in the small intestine, breaking fats, proteins and starches into pieces that can be absorbed. This reduces fatty stools (steatorrhoea), bloating and malabsorption and improves nutrition. The enzymes are inactivated by stomach acid, so most products are enteric-coated microspheres released in the duodenum.
- The diseased pancreas releases too few digestive enzymes
- Enteric-coated enzymes pass the stomach and open in the duodenum
- Lipase, protease and amylase digest fat, protein and starch
- Fatty stools fall and nutrients are absorbed
Indications
- Exocrine pancreatic insufficiency in cystic fibrosis Cystic fibrosis →
- Exocrine pancreatic insufficiency from chronic pancreatitis Chronic pancreatitis →
- After surgical removal of the pancreas
Adverse effects
Common
- Abdominal pain, bloating and gas
- Nausea, diarrhoea or constipation
- Headache, cough and sore throat
- Perianal irritation
- Mouth irritation if capsules are chewed or held in the mouth
Contraindications
- Allergy to pork proteins or to the product
- Caution with previous bowel surgery, strictures or obstruction
- Caution with gout, high uric acid or kidney disease
Key interactions
- Proton pump inhibitors and H2 blockers
- Used with uncoated enzyme tablets to protect them from stomach acid; can improve response to coated products
What is monitored
- Stool pattern, steatorrhoea and abdominal symptoms
- Weight, growth and nutritional status
- Uric acid when there is gout or kidney disease
- Signs of bowel obstruction
Administration and safety
- Taken with every meal and snack, with plenty of water
- Capsules and tablets are swallowed whole, never crushed, chewed or held in the mouth
- If capsules cannot be swallowed, the contents can be mixed with a small amount of soft acidic food and swallowed at once
- For infants the contents are not mixed with formula or breast milk, and the mouth is checked afterwards
- Products differ in strength and are not switched without the prescriber
Pregnancy and breastfeeding
The enzymes act inside the gut; human data are limited, and good nutrition is important during pregnancy.
Nursing care
- Give the enzymes at the start of each meal or snack, never on an empty stomach
- Check that capsules are swallowed whole and that no residue stays in the mouth
- Monitor weight, stools and abdominal pain
- Ask about pork allergy and religious or dietary concerns about porcine products
- Report severe abdominal pain, bloating or constipation, possible signs of obstruction or stricture
Pharmacokinetics
- Absorption
- Not meant to be absorbed: the enzymes act in the gut lumen
- Onset and duration
- Acts on the meal it is taken with
Test yourself
Think of the answer, then tap the question to see it.
Why must pancrelipase capsules be swallowed whole?
Chewing breaks the enteric coating so acid destroys the enzymes, and released enzymes can irritate the mouth.
Which colonic complication is linked to very high pancreatic enzyme doses in cystic fibrosis?
Fibrosing colonopathy (colonic strictures).
Why can pancrelipase raise uric acid?
Pancreatic extracts have a high purine content, which can cause hyperuricosuria, gout and kidney stones.
When is pancrelipase given in relation to food?
With every meal and snack, so the enzymes mix with the food in the intestine.
Connections
← Back to the class: Mucolytics and supportive cystic fibrosis therapies
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Pancrelipase: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); eEML - Electronic Essential Medicines List (World Health Organization, 2025); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.