Pancrelipase
Pancrelipase is a combination of digestive enzymes (lipase, protease, and amylase) extracted primarily from porcine (pork) pancreas. It is the cornerstone of therapy for **Exocrine Pancreatic Insufficiency (EPI)**, a condition where the pancreas fails to synthesize and secrete adequate digestive enzymes, leading to severe maldigestion, weight loss despite polyphagia, and voluminous, steatorrheic feces. **Clinical Pearls:** * EPI is notably prevalent in certain breeds like German Shepherd Dogs and Rough Collies due to pancreatic acinar atrophy. * Diagnosis is typically confirmed via a species-specific **Trypsin-Like Immunoreactivity (TLI)** assay. * While highly effective, about 15% of dogs may not respond optimally to enzyme replacement alone and may require concurrent management of dysbiosis (antibiotic-responsive enteropathy), dietary modifications (e.g., highly digestible, low-fiber diets), or cobalamin (Vitamin B12) supplementation.
Mechanism: Pancrelipase acts locally in the duodenum and jejunum to replace missing endogenous pancreatic enzymes, facilitating the breakdown of macronutrients into absorbable molecules: * **Lipase** hydrolyzes triglycerides โ free fatty acids and monoglycerides. * **Protease** (including trypsin and chymotrypsin) cleaves peptide bonds in proteins โ oligopeptides and free amino acids. * **Amylase** hydrolyzes complex carbohydrates (starches) โ dextrins and simple sugars (maltose). These enzymes resolve maldigestion and secondary malabsorption, allowing the animal to properly absorb nutrients and gain weight.
Dosing by species
- Pancreatic exocrine insufficiency ยท 0.5-0.75 teaspoonsful with each meal mixed with food ยท PO ยท with each meal ยท Mix with food thoroughly and allow it to stand for 15-20 minutes before feeding. Best results are usually obtained by feeding small meals frequently (at least 3 times per day).
- Pancreatic exocrine insufficiency ยท 1 teaspoonful of powder or finely crushed nonenteric-coated tablets to each of two meals of balanced feline ration ยท PO ยท with each meal (twice daily) ยท Cats that refuse to eat food treated with powder may be dosed with capsules filled with powder or crushed non-enteric coated tablets. Not necessary to incubate before feeding.
- Pancreatic exocrine insufficiency ยท 0.5 teaspoonsful of powder per meal ยท PO ยท with each meal
- Pancreatic exocrine insufficiency ยท Initially, one teaspoon per cat per meal ยท PO ยท with each meal ยท When clinical signs have resolved, gradually decrease to the lowest effective dose.
- Pancreatic exocrine insufficiency ยท 1/8 tsp per kg ยท PO ยท with meals ยท Mix with moistened feed or administer by gavage. Incubate with food for 15 minutes prior to gavage.
- Gastric trichobezoars (Rabbits) ยท 1 teaspoonful (5 mL) pancrelipase powder plus 3 teaspoonsful (15 mL) of yogurt; let stand for 15 minutes, then give 2-3 mL ยท PO ยท q12h ยท Questionable efficacy for removing 'hairballs', but might help dissolve the protein matrix surrounding hair.
Routes of administration
Contraindications
- Hypersensitivity to pork proteins
Adverse effects
- GI distress (diarrhea, cramping, nausea) at high doses
- Oral or esophageal ulcers (from concentrated enzymes)
- Oral bleeding (reported in dogs)
Drug interactions
- Antacids (magnesium hydroxide, calcium carbonate) ยท May diminish the effectiveness of pancrelipase
- Cimetidine (or other H2 antagonists) ยท May increase the amount of pancrelipase that reaches the duodenum
Monitoring
- Animal's weight
- Stool consistency and frequency
Overdose
Overdosage may cause diarrhea or other intestinal upset (cramping, nausea). The effects should be temporary; treat by reducing the dosage and providing supportive care if diarrhea is severe.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturerโs current label.