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Pancrelipase

By Rania Gollakner, BS, DVM, MPH

Medications

What is pancrelipase?

Pancrelipase (brand names: Viokase®, Epizyme®, Panakare®, Pancrepowder Plus®, Pancreved®, Parcrezyme®) is a pancreatic enzyme supplement that is used to treat exocrine pancreatic enzyme insufficiency (EPI) in dogs, cats, and birds. EPI is when the pancreas is unable to make enough enzymes used for digestion. In rabbits, it has also been used to treat fur balls.

Dietary supplements are substances that can be used to supplement the diet, such as vitamins, minerals, amino acids, herbs, botanicals, enzymes, and probiotics. While some supplements are sold over the counter, they still contain ingredients that have biological effects that should be managed by your veterinarian. Follow your veterinarian’s directions and cautions very carefully as their directions may be significantly different from those on the label.

There are differences in how countries regulate supplements. In the United States, these substances are not as vigorously regulated by the FDA as other medications, which means they can be sold without the manufacturer proving their effectiveness, safety, and without a guarantee of consistent or accurately reported ingredients. In Canada, products that have been evaluated for quality, safety, and effectiveness by Health Canada and authorized for sale will have a license number on the label.

How effective is pancrelipase?

Pancrelipase is very effective when treating EPI in about 85% of the cases, especially when used with an appropriate lower fat diet. In the other 15% of the cases, response to therapy is poor, usually due to concurrent complications. The products labeled for animals may be more effective than the human formulations.

How is pancrelipase given?

Pancrelipase is given by mouth in the form of a powder, crushed tablet, enteric-coated tablets, or compounded capsules. Thoroughly mix the powder or crushed tablets into the food and let it stand 15-20 minutes prior to feeding. Immediately after administering the whole tablets or capsules, administer food or water. Do not get this supplement on your skin or accidentally inhale the powder, as this supplement can cause irritation. Wash your skin thoroughly if contact occurs.

This medication should take effect within 1 to 2 hours; however, effects may not be visibly obvious and therefore laboratory tests may need to be done to evaluate how well this medication is working.

What if I miss giving my pet the supplement?

If you miss a dose, skip the dose you missed and give it at the next scheduled feeding time, and then return to the regular dosing schedule. Never give your pet two doses at once or give extra doses.

Are there any potential side effects?

Side effects usually occur at higher doses and may include diarrhea, cramping, gas, or vomiting. Concentrated forms can cause ulcers in the mouth or esophagus, so it is important to follow dosing with additional food or water (water can be administered with a syringe). Serious side effects include bleeding from the mouth or difficulty swallowing.

This short-acting medication should stop working within 24 hours, although effects can be longer in pets with liver or kidney disease.

Are there any risk factors for this supplement?

Do not use this supplement in pets that are allergic to pork. Use concentrated forms cautiously as they can cause ulcers in the mouth or esophagus; follow dosing with additional food or water. Use pancrelipase cautiously in pregnant or lactating pets, as safety has not been established. Use cautiously in pets with current mouth or esophageal ulceration.

While administering this supplement, do not inhale the powder as lung irritation can occur. Avoid contact with the skin; if contact occurs, wash your skin immediately.

Are there any drug interactions I should be aware of?

The following medications should be used with caution when given with pancrelipase: antacids or cimetidine.

Vitamins, herbal therapies, and supplements have the potential to interact with each other, as well as with prescription and over the counter medications. It is important to tell your veterinarian about any medications (including all vitamins, supplements, or herbal therapies) that your pet is taking.

Is there any monitoring that needs to be done with this supplement?

Your veterinarian may monitor your pet to be sure that the medication is working by monitoring your pet’s weight, stool frequency, and stool consistency. Monitor your pet at home for serious side effects.

How do I store pancrelipase?

Unless otherwise recommended, store this supplement at room temperature in a dry place; protect from moisture.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility.

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