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.
Mecanismo: 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 → free fatty acids and monoglycerides. * **Protease** (including trypsin and chymotrypsin) cleaves peptide bonds in proteins → oligopeptides and free amino acids. * **Amylase** hydrolyzes complex carbohydrates (starches) → dextrins and simple sugars (maltose). These enzymes resolve maldigestion and secondary malabsorption, allowing the animal to properly absorb nutrients and gain weight.
Dosificación por especie
- Pancreatic exocrine insufficiency · 0.5-0.75 teaspoonsful with each meal mixed with food · PO · with each meal · 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 · 1 teaspoonful of powder or finely crushed nonenteric-coated tablets to each of two meals of balanced feline ration · PO · with each meal (twice daily) · 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 · 0.5 teaspoonsful of powder per meal · PO · with each meal
- Pancreatic exocrine insufficiency · Initially, one teaspoon per cat per meal · PO · with each meal · When clinical signs have resolved, gradually decrease to the lowest effective dose.
- Pancreatic exocrine insufficiency · 1/8 tsp per kg · PO · with meals · Mix with moistened feed or administer by gavage. Incubate with food for 15 minutes prior to gavage.
- Gastric trichobezoars (Rabbits) · 1 teaspoonful (5 mL) pancrelipase powder plus 3 teaspoonsful (15 mL) of yogurt; let stand for 15 minutes, then give 2-3 mL · PO · q12h · Questionable efficacy for removing 'hairballs', but might help dissolve the protein matrix surrounding hair.
Vías de administración
Contraindicaciones
- Hypersensitivity to pork proteins
Efectos adversos
- GI distress (diarrhea, cramping, nausea) at high doses
- Oral or esophageal ulcers (from concentrated enzymes)
- Oral bleeding (reported in dogs)
Interacciones farmacológicas
- Antacids (magnesium hydroxide, calcium carbonate) · May diminish the effectiveness of pancrelipase
- Cimetidine (or other H2 antagonists) · May increase the amount of pancrelipase that reaches the duodenum
Monitorización
- Animal's weight
- Stool consistency and frequency
Sobredosis
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.
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