All the Rx pancrealipase products are the same as far as the basic ingredients go of amylase, lipase and protease. But because of differences in manufacturing processes of how the enzymes are extracted from porcine pancreas, concentrated, purified, and enteric coatings used, each one will perform differently within the same patient. One’s body chemistry differs as well, so this is why it is worth trying different brands to see which one performs best. In the product insert for Creon under the heading “Dosage and Administration” it is stated: “CREON is not interchangeable with any other pancrealipase product (2.1)

The (2.1) refers to the specific section of the product insert regarding administration. It discusses that it requires being optimized by the patient for the specific meal based on food quantity and particularly fat content. There are two ways to do this: keeping a daily food journal noting date/time, meal type, quantities of each food item and particularly fat content. After consumption, noting any GI symptoms related to EPI. If noting noted, the number of capsules was sufficient. If there is excessive gas, changes in stool, steatorrhea, light yellow or light orange color to stool that appears oily and floats with a greasy sheen on the toilet water, it indicated undigested fat. Either eliminate the excess fat from the diet or increase the number of capsules. What is initially prescribed in amount to take is just a “ball-park” figure. One needs to optimize.

An easier way to optimize is going to the site https://digestthis.ca. It is an on-line dosing calculator developed by the Canadian Digestive Health Association in collaboration with Craig’s Cause Pancreatic Cancer Society of Canada. It eliminates most of the trial and error. It works with all the Rx brands of pancrealipase (Creon, Zenpep, Viokace, Pertzye and Pancreaze.

A little more about the misconception that enzyme brands are all identical. During the years I worked in the clinical research lab, I was exposed to enzymology. I had to produce an enzyme from an animal source for an experiment I repeatedly did as part of a long-term clinical investigation. It was a tedious process requiring extraction, purification by dialysis and concentration using a lyophilization process. In looking to find a more efficient method, I was made aware of other processes and gave those a try. I then had to compare the new preparation method with the one currently used. So in addition to quality control steps and making sure the enzyme activity was relatively the same, the other production methods did not work as well. While they were easier for producing the needed enzyme, the enzyme activity was not as efficient as the original.

So when someone says enzymes are enzymes and no need to switch….think twice. It doesn’t hurt to try and physicians and registered dietitians have access to physician samples they can provide to do an evaluation before the prescription is changed to see if an alternate brand performs better.