{"entity":{"id":"pancrelipase","kind":"drug","name":"Pancrelipase (pancreatic enzyme replacement therapy)","aka":["PERT","Pancreatin","Pancreatic enzyme replacement therapy","Enteric-coated pancreatin"],"tldr":"Enzyme capsules taken with every meal replace the digestive enzymes a pancreas blocked or removed by cancer no longer delivers; NICE says to offer them to everyone with unresectable pancreatic cancer and to consider them around surgery.","summary":"Pancreatic exocrine insufficiency, with fat malabsorption, steatorrhoea and weight loss, affects about 72 percent of people with advanced pancreatic cancer and is commoner with tumours of the head (relative risk 3.36) (Iglesia 2020, seven cohorts). NICE NG85 recommends enteric-coated pancreatin for people with unresectable pancreatic cancer (1.6.1) and says to consider it before and after resection (1.6.2); it notes the September 2024 supply disruption and points to the Specialist Pharmacy Service tool for equivalent products. Evidence of benefit is mixed: observational studies pooled by Iglesia and colleagues associate replacement with 3.8 months longer survival and better quality of life, but the one multicentre randomised trial (88 patients on chemotherapy for unresectable disease, 48,000 lipase units a meal) found no difference in body mass index at eight weeks (Saito 2018). Dosing is titrated to symptoms, typically 40,000 to 50,000 units of lipase with meals and half that with snacks, taken with the first mouthfuls; acid suppression is added when response is poor.","status":"established","asOf":"2026-09-24","wikipedia":"https://en.wikipedia.org/wiki/Pancrelipase","links":[{"label":"NICE NG85 recommendations 1.6.1 to 1.6.3: nutritional management","url":"https://www.nice.org.uk/guidance/ng85/chapter/Recommendations"},{"label":"Saito et al., randomised trial of pancreatic enzyme replacement in unresectable pancreatic cancer (Pancreas 2018)","url":"https://doi.org/10.1097/MPA.0000000000001079"},{"label":"Iglesia et al., meta-analysis (UEG Journal 2020)","url":"https://doi.org/10.1177/2050640620938987"}],"tags":[],"related":[],"cancers":["pancreatic","locally-advanced-pdac","metastatic-pdac","resectable-pdac"],"sections":[],"technologies":["oncology-nutrition"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["cachexia","malnutrition-screening","pancreatic-palliation-obstruction-pain-nutrition"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"brand":"Creon, Nutrizym, Pancrease","modality":"Oral porcine pancreatic enzymes (lipase, protease, amylase) in enteric-coated capsules","supportive":true,"mechanism":"Replaces lipase, protease and amylase in the duodenum so that fat, protein and starch are digested; the enteric coating releases the enzymes at the alkaline pH of the small bowel.","approvals":[],"mechanismSteps":[],"toxicity":[],"access":[],"regulatoryEvents":[]},"route":"/drugs/pancrelipase/","neighbours":{"cancer":[{"id":"locally-advanced-pdac","kind":"cancer","name":"Locally advanced unresectable pancreatic ductal adenocarcinoma","route":"/cancers/locally-advanced-pdac/"},{"id":"metastatic-pdac","kind":"cancer","name":"Metastatic pancreatic ductal adenocarcinoma","route":"/cancers/metastatic-pdac/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"resectable-pdac","kind":"cancer","name":"Resectable pancreatic ductal adenocarcinoma","route":"/cancers/resectable-pdac/"}],"technology":[{"id":"oncology-nutrition","kind":"technology","name":"Nutrition support and cachexia management","route":"/technologies/oncology-nutrition/"}],"term":[{"id":"cachexia","kind":"term","name":"Cancer cachexia","route":"/terms/cachexia/"},{"id":"malnutrition-screening","kind":"term","name":"Malnutrition screening tools (MUST, NRS-2002, MST, PG-SGA)","route":"/terms/malnutrition-screening/"},{"id":"pancreatic-palliation-obstruction-pain-nutrition","kind":"term","name":"Palliation in pancreatic cancer: biliary and duodenal stents, coeliac plexus block, enzymes and cachexia","route":"/terms/pancreatic-palliation-obstruction-pain-nutrition/"}]}}