Initiating Pancreatic Enzyme Replacement Therapy (PERT) — PERT Formulations — Clinical Pathway: All Settings

Clinical Pathway for Pancreatic Enzyme Replacement Therapy (PERT) in Children with or at Risk for Exocrine Pancreatic Insufficiency (EPI)

PERT Formulations

PERT contains lipase, protease, and amylase. Each brand comes in multiple strengths; the number associated with each size signifies the amount of lipase. There are 3 formulations: enteric-coated, non-enteric-coated, and a lipase enzyme cartridge. Store enzymes in a cool, dry place to prevent inactivation by heat. Common Products

Enzyme Types and Considerations

Enzyme Type Considerations
Enteric-coated
  • Capsules containing enteric-coated beads or micro tablets
  • Enteric coating protects enzymes from gastric acid, allows activation in duodenum
  • Administration
    • Give by mouth even if portion of their feeding is via an enteral tube
      • Swallowed whole or opened, and contents sprinkled on a small amount of applesauce
      • Give by mouth even if portion of their feeding is via an enteral tube

      • Do Not
        • Administer enteric-coated beads via feeding tube, will clog tube
        • Crush or chew enzyme beads
Non-enteric-coated (Viokace)
  • Powdered tablets
  • Most often used for patients on tube feeds
  • Administration
    • Crush and add to enteral formula to pre-digest nutrients in feeding bag before enteral tube administration
    • Do Not Give Orally for Treatment of Pancreatic Insufficiency
    • Viokace Patient Instructions
Lipase Cartridge (RELiZORB)
  • Enzyme cartridge only containing enzyme Lipase
  • For patients on continuous tube feeds only