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 PERT if you have pancreatic cancer.

Taking pancreatic enzyme replacement therapy (PERT)

Enzymes are normally taken as capsules that you take with food.

How much PERT should I take?

Some brands of enzymes have a number after the name, which shows the dose of enzymes in each capsule. For example, a capsule of 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 given a different brand.

There is no set dose of enzymes for each day. Take as many as you need. 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, you might take two or three capsules containing 25,000 units 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. A healthy pancreas would normally make up to 720,000 units for a small meal.

Most people will need to increase the number of enzymes they take from the starting dose. 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.

You will need to take more enzymes for larger meals and for fatty foods, as these need more enzymes to digest them. Don’t change what you eat to try to manage your symptoms as you may not get all the nutrients you need. Just make sure you take enough enzymes for what you are eating. For example, don’t try to reduce fat. Just take more enzymes if you are eating fatty foods. Speak to your doctor or dietitian before making any major changes to your diet.

It may take a few days to notice an effect when you first start to take PERT. For the first few weeks you take PERT, you may find it helpful to keep a food diary. Note down what you eat, the dose of enzymes you take, and if this makes your symptoms better. This can help you work out if you are taking enough enzymes with different foods.

Once problems with your digestion start to improve, you may start to eat more. So you may need more enzymes to digest your food.

‘’ In view of my weight loss it was suggested by a Specialist Nurse at Pancreatic Cancer UK that I may benefit from enzyme tablets. I started taking the capsules and noticed straight away less discomfort on eating. My energy levels started to increase and I have very slowly started to gain some weight.”

Watch our video on taking pancreatic enzyme replacement therapy

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

How to take pancreatic enzymes

Make sure you take PERT properly, to help it work well.

Do

  • Take PERT with all meals and snacks. You should also take it with drinks that are more than half milk.
  • Swallow the capsules whole, with a couple of sips of a cool drink. The enzymes won’t work properly if you take them with hot drinks. Read about what to do if you struggle to swallow capsules.
  • Take half the capsules with the first few mouthfuls of food. Spread the other half out during the meal.
  • You will need more enzymes for larger meals or meals with several courses. You will also need more for fatty food. For example, take extra capsules with takeaways, roasted or fried food, puddings, or food with lots of cheese or chocolate.
  • If you take nutritional supplements, you will need to take enzymes with these as well.

Do not

  • Do not chew the capsules as this can cause a sore mouth.
  • Don’t worry if you forget to take your enzymes. Just take the usual dose with your next meal or snack. You may have some symptoms for the next day or two, but this will improve.
  • Do not store the capsules in hot places as this can stop them working properly. For example, do not leave them in the car, near radiators, in direct sunlight, or in trouser pockets.
  • You don’t need to take the capsules if you are not eating or drinking. They only work when taken with food.

There are some foods and drinks that you do not need to take enzymes with. These include:

  • drinks with only a splash of milk (including tea or coffee)
  • fruit juice, fruit squashes, or fizzy drinks (except fruit smoothies)
  • alcoholic drinks, unless they contain milk or egg
  • small amounts of fruit or dried fruit
  • small amounts of plain vegetables (except potatoes, beans, avocados and pulses such as lentils)
  • sugary sweets like jelly babies, wine gums, mints, fruit pastilles or marshmallows.

"I’ve regained a healthy weight. There’s nothing I can’t eat. If a meal looks a bit more fatty than the average I just take an extra capsule."

Iain

What if I find it hard to swallow the capsules?

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

You can open the capsules and mix the granules inside with a teaspoon of cold, soft, acidic food such as smooth apple sauce, fruit puree, apricot jam or yoghurt. Swallow this straight away, then rinse your mouth with a small amount of a cool drink. This is to make sure you swallow all the granules. Do not chew the granules. If the granules are not swallowed quickly, or get stuck between your teeth or dentures, they can cause mouth ulcers.

Do not mix the granules with hot foods or drinks, as this will stop the enzymes working. You should not sprinkle the granules on a plate of food, as they won’t work this way either.

Questions about PERT?

Speak to our specialist nurses on the Support Line if you have any questions about how to take PERT.

Specialist nurse Support Line
Woman on phone

"My weight is stable. I have not put back all the weight I lost post-surgery but think I look well and I eat well and healthily."

Ask a Dietitian webinar | Tuesday 19th March, 5.30pm - 7pm

Join us for a free evening webinar covering diet, digestion and PERT. There will be a Q&A session with our specialist dietitian speakers at the end. 

Find out more and book your free place

Updated March 2023

Review date March 2025