How do I take pancreatic enzyme replacement therapy?

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.

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.