How do I take pancreatic enzyme replacement therapy?

Pancreatic enzymes are normally capsules that you take with food. This page explains how and when to take these capsules if you have pancreatic cancer.

Pancreatic enzyme replacement therapy replaces the enzymes that your pancreas would normally make. If you have pancreatic cancer, taking pancreatic enzymes can help you digest your food.

This can help with symptoms such as weight loss, runny poo (diarrhoea) or losing your appetite.

Pancreatic enzymes are normally given as capsules that you swallow with food. They are also available as granules or powder if you struggle to swallow capsules.

Some brands of enzymes have a number after the name, which shows the dose of the enzymes. For example, Creon 25,000 contains 25,000 units and Nutrizym 22 contains 22,000 units. We have used these brands as an example, but you may be prescribed a different brand.

Watch our video on taking pancreatic enzyme replacement therapy

Our specialist nurse, Jeni, explains how to take pancreatic enzymes in this video.

What dose of enzymes do I need to take?

You might start with a dose of at least 50,000 or 75,000 units for a main meal, and 25,000 or 50,000 units for a snack or milky drink. For example, if you are taking a capsule that contains 25,000 units you might take two or three capsules with a main meal and one or two capsules with a snack.

This may sound like a lot of enzymes – but it’s not as much as your pancreas would normally make. During and after a small meal, your pancreas would normally make up to 720,000 units.

Most people will need to increase the number of enzymes they take from the starting dose. Improving problems with your digestion can mean that you start to eat more, and need more pancreatic enzymes to digest your food. Your dietitian, doctor or nurse can tell you how to work out the best dose of enzymes for you. They should review the dose regularly.

There is no set dose of enzymes for each day. You will need to take more for larger meals and more for fatty foods, as these need more enzymes to digest them. Don’t change what you eat to try to manage your symptoms – just make sure you take enough enzymes for what you are eating. Speak to your doctor or dietitian before making any major changes to your diet.

You may find it helpful to keep a diary of what you have eaten, the dose of enzymes you took, and if this made your symptoms better. This can help you work out if you are taking enough enzymes.

Taking pancreatic enzymes

It’s important that you take the enzymes properly, to make sure they work well.

Enzymes should be taken with all meals and snacks. You should also take them with milky drinks.
Swallow the capsules whole with a couple of sips of a drink. Don’t take the capsules with hot drinks, as they won’t work properly. If you are eating hot food, make sure you swallow the capsules with a cold drink.
Don’t chew the capsules as this can cause mouth ulcers. Read more about what to do if you struggle to swallow capsules.
You should take the enzymes with the first few mouthfuls of food. They won’t work properly if you take them after a meal.
If you are taking more than one capsule, or your meal will last more than 20 minutes, take half the capsules when you start eating, and spread the other half out during the meal.
You will need more enzymes for larger meals, or if the food has more fat in it – for example takeaways, roasted or fried food, puddings, or food with lots of cheese or chocolate.
Don’t worry if you forget to take your enzymes. Just take the usual dose with your next meal or snack.
If you take nutritional supplement drinks, you will need to take enzymes with these as well.
Don’t store the capsules in hot places as this can stop them working properly. For example, don’t leave them in the glove box of your car, near radiators, in direct sunlight, or in trouser pockets.

When NOT to take pancreatic enzymes

Pancreatic enzymes only work when they are taken with food. There are some foods and drinks that you don’t need to take enzymes with. These include:

drinks with only a splash of milk (including tea or coffee), fruit squashes, or fizzy drinks
alcoholic drinks
small amounts of fruit (except bananas and avocados) or dried fruit
small amounts of vegetables (except potatoes, beans, and pulses such as lentils)
sugary sweets – for example, jelly babies, wine gums, fruit pastilles or marshmallows.

“I do find eating little and often works best. The only foods that really give me problems are fatty, greasy ones and sometimes dairy. Since taking Creon I have noticed a big improvement.”

What if I can’t swallow the capsules?

It is best to take the capsules whole as they work better this way. If you find it difficult to swallow the capsules, speak to your doctor, nurse or dietitian. There are smaller capsules available, but you may have to take more of these to make up the dose.

You can open the capsule and mix the granules inside with a teaspoon of cold, soft, acidic food – such as a smooth apple sauce, fruit puree, apricot jam or fruit yoghurt. Swallow the food straight away and wash it down with a cool drink to rinse your mouth. Don’t mix the granules with hot foods or drinks, as this will stop the enzymes working. Don’t sprinkle the granules on a plate of food, as they won’t work this way either.

Don’t chew the granules. If the granules aren’t swallowed quickly, or get stuck between your teeth or dentures, they can cause mouth ulcers.