How do I take pancreatic enzyme replacement therapy?

Pancreatic enzyme replacement therapy (PERT) can help you manage digestion symptoms. Brands in the UK are Creon^®, Nutrizym^® and Pancrex^®.

We are aware of supply problems with some brands of PERT at the moment. Find out more in our blog.

When should I take PERT?

• You will need to take PERT with all meals and snacks.
• You should also take it with drinks that are made up of more than half milk.
• Take half the capsules with the first few mouthfuls of food. Spread the other half out during the meal.

How much PERT should I take?

Some brands of PERT 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 PERT for each day. Take as much 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 Creon 25,000 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 about 720,000 units for a small meal.

How do I get the dose right?

Most people will need to increase how much PERT they take from the starting dose. Your dietitian, doctor or nurse can tell you how to work out the best dose of PERT for you. They should review the dose regularly.

It may take a few days to notice an effect when you first start to take PERT.

Once problems with your digestion start to improve, you may start to eat more and may need more PERT.

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 PERT

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.
• 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 pockets.
• You don’t need to take the capsules if you are not eating or drinking. They only work when taken with food.

What if I forget to take my PERT?

Don’t worry if you forget to take your PERT. Just take the usual dose with your next meal or snack. You may get some symptoms but keep taking your PERT and this will soon improve.

There are some foods and drinks that you do not need to take PERT 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.

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.

Can I open the capsules?

• 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 fruit 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. If the granules are not swallowed completely, they might get stuck around your gums or mouth and could cause ulcers.
• Do not chew the granules.
• Do not mix the granules with hot foods or drinks, as this will stop the PERT working. You should not sprinkle the granules on a plate of food, as they won’t work this way either.

If you go into hospital

If you go into hospital, tell the staff that you need to take PERT to help you digest your food. Sometimes hospital staff only give PERT when they give other medicines, but this might not be at mealtimes. Explain that PERT only works if you take it when you eat, and that you need more if you are eating more.

Ask the hospital staff if you can keep PERT with you to take with any food, including snacks and milky drinks. Some hospitals may let you do this. You could show them this webpage. If they don’t let you keep it, speak to your medical team or dietitian as they may be able to help.

Updated March 2025

Review date March 2028