Pancreatin

Latin name

Pancreatin

Pharmacological group

Enzymes and anti-enzymes

Nosological classification (ICD-10)

Characteristic

Enzyme preparation from the pancreas of pigs and large cattle. Amorphous fine grayish or yellowish powder with a characteristic odor. Slightly soluble in water.

Pharmacology

Pharmacological action - replenishing the deficiency of pancreatic enzymes.

Contains excretory pancreatic enzymes: lipase, alpha-amylase, trypsin, chymotrypsin, promotes the breakdown of proteins (to amino acids), fats (to glycerol and fatty acids) and starch (to dextrins and monosaccharides), normalizes digestion processes. The enzymes that make up pancreatin are released in an alkaline environment. small intestine, because protected from the action of gastric juice by the shell. Trypsin in the upper small intestine inhibits stimulated pancreatic secretion, causing the analgesic effect of pancreatin.

Application

Insufficiency of digestion in violation of the exocrine function of the pancreas: cystic fibrosis, chronic pancreatitis, pancreatectomy, dyspepsia, Roemheld's syndrome, flatulence; violation of food absorption (condition after resection of the stomach and small intestine, accelerated passage of food through the intestines, errors in the diet when taking fatty, unusual or indigestible food, with nervousness, etc.), intestinal infections, chronic diseases in the system of the liver and biliary tract, intestinal degassing before diagnostic studies(X-ray, ultrasound, etc.).

Contraindications

Hypersensitivity (including intolerance to pork), acute pancreatitis exacerbation of chronic pancreatitis.

Side effects

Symptoms intestinal obstruction(formation of strictures in the ileocecal region and ascending colon) and allergic reactions immediate type(with cystic fibrosis, especially in children).

Interaction

Reduces iron absorption (especially when long-term use).

Dosage and administration

Inside, before meals, without chewing, with plenty of liquid, preferably alkaline: water, fruit juices. The dose is set individually depending on the severity of the digestive disorder. In the usual dose - 0.25-0.5 g 3-6 times a day immediately before meals or during meals. Duration of treatment - from several days (in violation of the digestive process due to errors in the diet) to several months and even years (if replacement therapy is necessary).

Precautionary measures

Year of last adjustment

1999

Interactions with other active substances

Trade names of drugs with active substance

Tradename	The value of the Wyshkovsky Index
Gastenorm forte	0,0326
Gastenorm forte 10000	0,0246
Creon ® 10000	2,3244
Creon ® 25000	0,7757
Creon ® 40000	0,0599
Mezim ® forte	0,5043
Mezim ® forte 10000	0,2588
Micrasim ®	0,5648
PanziKam	0,02
Panzim ® forte	0,0565

Enzymatic pancreatic juice, which is rich in various enzymes (lipase, amylase, trypsin, etc.) and which is secreted into the duodenum, is of great importance for the entire digestion process.

Various violations of the activity of pancreatic enzymes, as well as violations of its secretory function, lead to a disease such as pancreatitis. Pancreatitis can occur with low acidity of gastric juice, with intoxication, with circulatory disorders, with diseases of the gastrointestinal tract. Often pancreatitis is the result of unsystematic and irrational nutrition.

Drugs that affect the exocrine function of the pancreas, stimulate the release of enzymes, or may be means of replacement therapy. Another group of drugs that affect the function of the pancreas - the so-called anti enzyme preparations.

However, it should be noted that, unfortunately, the number is really effective drugs for the treatment of disorders of the pancreas is not too great. This list has not grown much since recent years twenty, and special achievements in the treatment of diseases such as the same pancreatitis have not been observed for a long time. To pathogenetic agents, i.e. means that eliminate pathology can be attributed, and even then only conditionally, means of replacement therapy and enzyme preparations. Although in these cases this classification raises many doubts: the same enzyme preparations do not affect the pathology, but supply those necessary enzymes for digestion that the diseased pancreas does not secrete.

ENZYME PREPARATIONS

Enzyme preparations are drugs used for insufficient pancreatic function.

PANCREATIN- a drug that is obtained from the pancreas of slaughter cattle, containing the enzymes trypsin and amylase. Pancreatin is used for low acidity of gastric juice, for diseases of the pancreas and liver with symptoms of hypofunction, for gastritis, and digestive disorders. Release form of pancreatin: powder (in 1 g 0.25 IU) and tablets of 0.5 g.

An example of a pancreatin recipe in Latin:

Rep.: Tab. Pancreatini 0.5 N. 20

D.S. 1-2 tablets 3-4 times a day before meals.

PANZINORM (forte) - is one two-layer tablet containing an extract of the gastric mucosa and amino acids in the outer layer, and an acid-resistant core - bile extract and bovine pancreatin. Pepsin is released in the stomach, the rest of the constituents - in duodenum. Penzinorm release form: tablets.

An example of a penzinorm recipe in Latin:

Rep.: Tab. "Panzinorm" N. 30

D.S. 1-2 tablets (with meals) 3 times a day.

MEKSAZA- composition: bromelain - 0.05 g; pancreatin - 015 g; dehydrocholic acid - 0.025 g; enteroseptol (5-chloro-7-iodoxyquinoline) - 0.1 g; 4,7-phenanthroline-5,6-quinone - 0.01 g. Mexase release form: dragee.

An example of a mexase recipe in Latin:

Rp.: Dragee "Mexase" N. 20

D. S. Inside, 1 tablet 3 times a day during or after meals.

FESTAL- composition: lipase, pancreatic protease, amylase, hemicellulase and bile components. Form release festal: dragee.

An example of a festal recipe in Latin:

Rp.: Dragee "Festal" N. 50

D.S. Take 1-2 tablets orally during or immediately after a meal.

ORAZA- the preparation contains a complex of proteolytic and amylolytic enzymes. Oraza is used for digestive disorders that occur with inhibition of the function of the digestive glands (hypoacid and anacid gastritis, chronic pancreatitis with impaired excretory function, chronic cholecystitis and etc.). The course of treatment lasts 2-4 weeks. Side effects of oraz: may increase diarrhea in people suffering from diarrhea. Oraza release form: granules.

An example of an oraz recipe in Latin:

Rp.: Gran. Orazi 200.0

D.S. 1/2 teaspoon of granules (2 g) 3 times a day during or after meals.

SOLIZIM- enzymatic lipolytic preparation. Solizim is used for gastritis with low acidity, for chronic pancreatitis with reduced lipolytic activity, for hepatitis, etc. Solizim release form: tablets (20,000 LE).

An example of a solime recipe in Latin:

Rep.: Tab. Solizymi 20000 LE N. 100

D.S. Take with or immediately after meals 2 tablets 3 times daily (3-4 weeks).

SOMILASE- 1 tablet of the preparation contains 0.0286 g of solisim (20000 JIE) and 0.1363 g of amylase (300 IU). Somilase is used for gastritis, chronic pancreatitis, enteritis, cholecystitis, hepatitis, as well as after surgery on organs. gastrointestinal tract. Somilase release form: tablets.

PANKURMEN- indications for use are the same as for previous drugs; contains pancreatin and turmeric extract. Pankurmen release form: dragee.

An example of a pankurmen recipe in Latin:

Rp.: Dragee "Pancurmen" N. 20

D.S. 1-2 tablets 3 times a day.

DIGESTAL- the preparation contains pancreatin and bile extract, as well as hemicellulase. Digestal helps to improve digestion, reduce fermentation and the formation of gases in the intestines. Digestal is contraindicated in hepatitis. Release form of digestal: dragee.

An example of a digestal recipe in Latin:

Rp.: Dragee "Digestal" N. 30

D.S. 1-2 tablets 3 times a day during or after meals.

KOTAZIM-FORTE- contains trypsin, pancreatin, bile extract, bile acids and cellulase. Cotazim-forte is used for the same indications as the previous drugs. Release form of kotazim-forte: tablets.

An example of a cotazim-forte recipe in Latin:

Rep.: Tab. "Cotazym-forte" N. 60

D.S. 1 tablet 3 times a day during or after meals.

MEZIM-FORTE- contains amylase, pancreatin, protease, lipase. Indications for the use of mezima-forte are the same as for previous drugs. Mezima-forte release form: dragee.

An example of a mezima forte recipe in Latin:

Rp.: Dragee "Mezym-forte" N. 30

D.S. 1-3 tablets a day before meals.

ENZISTAL- an enzyme preparation that improves digestion. Enzistal dragee contains 192 mg of pancreatin, 50 mg of hemicellulase and 25 mg of bile extract. Assign 1-2 tablets 3 times a day (during or after meals).Enzistal release form: dragee.

CHRIFERMENT- contains trypsin, lipase, amylase. Indications for the use of chrienzyme are the same as for previous drugs. Chrienzyme release form: dragee.

An example of a chryferment recipe in Latin:

Rp.: Dragee "Triferment" N. 30

D. S. 1-3 tablets before meals 3 times a day (for adults), 1-2 tablets for children.

NIGEDASA- contains a lipolytic enzyme. Nigedase is used to compensate for the missing or missing lipolytic activity of duodenal juice, which is caused by damage to the digestive organs (cholecystopancreatitis, pancreatitis, enterocolitis, chronic hepatitis and gastritis). Nigedase is prescribed orally 1-2 tablets 10-30 minutes before meals. The course of treatment with nigedase is 3-4 weeks, but if necessary, can be extended. Side effects when using nigedaz: patients with colitis sometimes have pain in the abdomen, which disappear when the dose is reduced. Nigedase release form: tablets of 0.15 g.

An example of a nigedaz recipe in Latin:

Rep.: Tab. "Nigedasa" 0.15 N. 30

D.S. 1 tablet 10-30 minutes before meals.

ANTI-ENZYME DRUGS

Antienzymatic drugs are used for pancreatitis (acute and chronic forms).

PANTRIPIN- extract of the pancreas of cattle. Pantripin inhibits the activity of proteolytic enzymes. Pantripin is used with caution in people prone to allergic reactions. Treatment with pantrypin is carried out under the control of the content of amylase in the urine and blood. Pantrypin release form: bottles containing 6 units, 12 units, 15 units, 20 units and 30 units.

An example of a pantrypin recipe in Latin:

Rp.: Pantrypini 30 ED

D.t. d. No. 10

S. Dilute 30-120 units of the drug in 500-1000 ml of isotonic sodium chloride solution or 5% glucose solution (with the addition of 1 unit of insulin per 3 g of glucose). Enter intravenously drip (40 drops per minute or once 25-30 IU, no more than 120 IU).

APROTININ(pharmacological analogues:gordox, contrical, trasilol, traskolan, tzalol ) - a polypeptide preparation obtained from the lungs of cattle, inhibits the activity of trypsin, kallikrein, plasmin. Side effects when using aprotinin: allergic reactions are possible. Release form of aprotinin: 5 ml ampoules containing 25,000 IU with the attached solvent; Gordox - 10 ml ampoules containing 100,000 IU, counterkal - 10,000; 30000 and 50000 units.

An example of aprotinin recipe in Latin:

Rp.: "Gordox" 100000 ED

D.t. d. N. 10 ampull.

S. Administer intravenously by drip, at an initial dose of 500,000 IU and then 50,000 IU per hour. When the condition improves - a daily dose of 300,000-500,000 units.

Rp.: "Contrycab 30000 ED

D.t. d. N. 3 in amp.

S. Dissolve the contents of the ampoule, inject intravenously (slowly or drip) 10,000-20,000 IU (at the same time no more than 50,000 IU).

Rp.: "Trasylol" 5 ml (25000 ED)

D.t. d. N. 10 ampull.

S. Inject intravenously simultaneously (slowly) or drip by 5 ml, gradually increasing the dose.

INGITRIL- according to the method of preparation and action, it is close to aprotinin. Ingitril has the same side effects when applied. Ingitril is contraindicated in patients with increased blood clotting. Ingitril release form: bottles of 15 IU and 20 IU of the drug.

An example of an ingitril recipe in Latin:

Rp.: Ingitrili 20 ED

D.t. d. No. 10

S. Dissolve the contents of the vial with 500-1000 ml of isotonic sodium chloride solution, inject intravenously (drip, jet) 200 IU / day.

Participate in the digestion of carbohydrates, fats and proteins. It is used for diseases of the gastrointestinal tract and in cases of nutritional error. Pancreatin compensates for the insufficient activity of its own enzymes, improves the digestion process. It is produced under different trade names: Biofestal, Normoenzym, Ferestal, Festal, Enzistal, Pankreoflat, Biozim, Vestal, Gastenorm, Creon, Mezim, "Mikrazim", "Panzim", "Pancreatin-Belmed", "Panzinorm", "Pancreazim", "Pancrelipase", "Pancrenorm", "Pantsitrat", "Penzital", "Uni-Festal", "Enzibene", "Ermital ”, “Evenzim”. It is dosed according to the amount of lipase in units.

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✪ Pancreatin - an enzyme drug

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✪ CHRONIC PANCREATITIS

Subtitles

Properties

An enzyme preparation from the pancreas of pigs and cattle. Amorphous fine grayish or yellowish powder with a characteristic odor. Slightly soluble in water.

In the acidic environment of the stomach, pancreatin quickly loses activity, so it is usually produced in an enteric coating. Activated in the intestine at =5.5. The average dose for adults is 150 thousand units / day.

Classification

Preparations containing pancreatic enzymes can be classified:

• By composition. Both pure pancreatin and containing additional substances can be used. This parameter defines indications and contraindications (additional components have their own contraindications):
  • pancreatin and choleretic agent;
  • pancreatin, bile components, hemicellulase;
  • pancreatin and rice fungus extract;
  • combined enzymes.
• According to resistance to hydrochloric acid of the stomach. Determines the effectiveness of the drug (in the acidic environment of the stomach, pancreatin loses its activity).
• The particle size of the drug. Affects the effectiveness, physiology of the drug (particle diameter less than 2 mm ensures synchronous flow of the drug with chyme into the duodenum).
  • conventional tablets;
  • microgranular forms (produced in the form of gelatin capsules containing acid-resistant microspheres or microtablets with a diameter of less than 2 mm).

Comparison of some brands

Tradename	Lipase, ED	Diameter	Other components
Creon	10000, 25000, 40000	less than 2 mm
Panzinorm	10000, 20000	less than 2 mm
Micrasim	10000, 25000	less than 2 mm
Mezim-forte	3500, 10000	more than 2 mm
Penzital	6000	more than 2 mm
Digestal	6000	more than 2 mm	bile, hemicellulase
Festal	6000	more than 2 mm	bile, hemicellulase
Ermital	10000, 25000, 36000	less than 2 mm
Enzistal	6000	more than 2 mm	bile, hemicellulase

Pharmacology

Digestive enzyme remedy, compensates for the deficiency of pancreatic enzymes, has a proteolytic, amylolytic and lipolytic effect. The pancreatic enzymes included in the composition (lipase, alpha-amylase, trypsin, chymotrypsin) contribute to the breakdown of proteins to amino acids, fats to glycerol and fatty acids, starch to dextrins and monosaccharides, improves the functional state of the gastrointestinal tract, normalizes digestion processes.

Trypsin inhibits stimulated pancreatic secretion, providing an analgesic effect.

Pancreatic enzymes are released from dosage form in the alkaline environment of the small intestine, as they are protected from the action of gastric juice by the shell.

The maximum enzymatic activity of the drug is observed 30-45 minutes after oral administration.

Indications

Insufficiency of the exocrine function of the pancreas (chronic pancreatitis, cystic fibrosis). Chronic inflammatory and dystrophic diseases of the stomach, intestines, liver, gallbladder, conditions after resection or irradiation of these organs, accompanied by disturbances in the digestion of food, flatulence, diarrhea (as part of Pancreatin 8000 table No. 50 combination therapy). To improve the digestion of food in persons with normal gastrointestinal function in case of nutritional errors, as well as in violation of chewing function. Preparation for X-ray and ultrasound abdominal organs.

Dosage and administration

The dose is selected individually depending on the degree of pancreatic insufficiency. The drug is used for adults at a dose of 1-4 tablets (corresponding to 8000-32000 IU FIP by lipase) with each meal. Assign tablets inside during or after a meal, without chewing, drinking plenty of liquid, preferably not alkaline: water, fruit juices. Daily dose 6-18 tablets (48000-150000 IU FIP). In complete pancreatic insufficiency (eg, cystic fibrosis), the dose should be increased to 49 tablets (400,000 IU FIP) per day, which corresponds to the daily requirement of an adult in lipase. The course of treatment can last from several days (in violation of the digestive process due to errors in the diet) to several months and even years (if necessary, in constant replacement therapy).

Efficiency

The effectiveness of enzyme preparations depends on the form of release (tablets or microtablets / minimicrospheres) and the clinical situation: in case of exacerbation of chronic pancreatitis, pancreatin tablets give the best effect, for the correction of exocrine pancreatic insufficiency - microtablet forms of preparations. Preparations with bile should not be used in patients with diseases of the biliary tract and hepatitis.

Side effect

When used, a hypersensitivity reaction is very rarely possible. With prolonged use of high doses of the drug, hyperuricosuria may occur. There may be symptoms of intestinal obstruction, stricture of the small intestine. . Immediate type allergic reactions are possible (with cystic fibrosis, especially in children).

Recipe (International)

Rp: Pancreatini 25 ED

D.t.d: №60 in tabl.

S: 1 tablet by mouth with food

pharmachologic effect

Enzyme agent. Contains pancreatic enzymes - amylase, lipase and protease, which facilitate the digestion of carbohydrates, fats and proteins, which contributes to their more complete absorption into small intestine. In diseases of the pancreas, it compensates for the insufficiency of its exocrine secretory function and improves the digestion process.

Mode of application

For adults: The dose (in terms of lipase) depends on the age and degree of pancreatic insufficiency. The average dose for adults is 150,000 IU / day. With complete insufficiency of the exocrine function of the pancreas - 400,000 IU / day, which corresponds to the daily requirement of an adult in lipase.

The maximum daily dose is 15,000 U/kg.
Children under the age of 1.5 years - 50,000 IU / day; older than 1.5 years - 100,000 IU / day.
The duration of treatment can vary from several days (in violation of the digestive process due to errors in the diet) to several months and even years (if necessary, constant replacement therapy).

Indications

Insufficiency of the exocrine function of the pancreas (including in chronic pancreatitis, cystic fibrosis).
- Chronic inflammatory-dystrophic diseases of the stomach, intestines, liver, gallbladder; conditions after resection or irradiation of these organs, accompanied by disorders of food digestion, flatulence, diarrhea (as part of combination therapy).
- To improve the digestion of food in patients with normal gastrointestinal function in case of nutritional errors, as well as in violation of chewing function, forced prolonged immobilization, sedentary lifestyle.
- Preparation for x-ray and ultrasound examination of the abdominal organs.

Contraindications

Acute pancreatitis.
- Hypersensitivity to pancreatin.

Side effects

From the side digestive system: in some cases - diarrhea, constipation, discomfort in the stomach, nausea. A causal relationship between the development of these reactions and the action of pancreatin has not been established; these phenomena are symptoms of exocrine pancreatic insufficiency.
- allergic reactions: in some cases - skin manifestations.
- From the side of metabolism: with prolonged use in high doses, hyperuricosuria may develop, in excessively high doses - an increase in the level of uric acid in the blood plasma.
- Others: when using pancreatin in high doses in children, perianal irritation may occur.

Release form

Enteric coated tablets
1 tab. pancreatin 90 mg, with enzymatic activity: lipases not less than 3500 IU, amylase not less than 3500 IU, proteases 200 IU.

Excipients: calcium stearate, lactose, low molecular weight povidone, microcrystalline cellulose.

The composition of the enteric coating: macrogol 6000, copolymer of methacrylic acid and ethyl acrylate, polysorbate-80, talc, azorubine dye, titanium dioxide.

10 pieces. - cellular contour packings (6) - packs of cardboard.
60 pcs. - jars of dark glass (1) - packs of cardboard.

ATTENTION!

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Active substance

ATH:

Pharmacological group

Nosological classification (ICD-10)

Composition and form of release

in a blister 10 pcs.; in a box of 5 blisters.

Description of the dosage form

Brown dragee with a smooth, shiny surface, when broken - light brown.

pharmachologic effect

pharmachologic effect- replenishing the deficiency of pancreatic enzymes.

Amylase, lipase and protease, which are part of the drug, facilitate the digestion of carbohydrates, fats and proteins, contributing to their more complete absorption in the small intestine.

Indications for Pancreatin

Insufficiency of the exocrine function of the pancreas (chronic pancreatitis, cystic fibrosis, etc.); chronic inflammatory-dystrophic diseases of the stomach, intestines, liver, gallbladder; conditions after resection or irradiation of these organs, accompanied by disorders of food digestion, flatulence, diarrhea (as part of combination therapy); improvement of food digestion in patients with normal gastrointestinal function in case of nutritional errors, as well as in violation of chewing function, with a sedentary lifestyle; in preparation for x-ray examination and abdominal ultrasound.

Contraindications

Hypersensitivity, acute pancreatitis, exacerbation of chronic pancreatitis.

Use during pregnancy and lactation

The safety of use during pregnancy has not been studied enough. Application is possible if the expected effect of therapy outweighs the potential risk to the fetus.

Side effects

Allergic reactions. With prolonged use in high doses, hyperuricemia and hyperuricuria are possible.

Interaction

It is possible to reduce the absorption of iron preparations. Antacids containing calcium carbonate and / or magnesium hydroxide may reduce the effectiveness of pancreatin.

Dosage and administration

inside, without chewing, during or after a meal. Adults - 1-3 tablets 3 times a day. Deyam - as prescribed by a doctor. The course of treatment - from several days (in violation of the digestive process due to errors in the diet) to several months or years (permanent replacement therapy).

Storage conditions of the drug Pancreatin

Store in a dry, dark place at temperatures below 25°C.

Keep out of the reach of children.

Shelf life of the drug Pancreatin

3 years.

Do not use after the expiry date stated on the packaging.