Comprehensive EPI management plan1-3
Once an EPI diagnosis has been made, there are a number of things to consider regarding a management plan.
- PERTs are the basis of therapy for treatment of EPI
- Eating a well-balanced diet
- Avoiding or limiting alcohol intake
- Smoking cessation
- Consider vitamin supplementation, including fat-soluble vitamins A, D, E, and K
EPI Management Plan
PERT is the standard of care for EPI2
PERTs help break down fats, proteins, and carbohydrates so they can be absorbed within the intestines and into the bloodstream.4
- REPLACE pancreatic enzymes in patients with EPI
- CONTAIN lipase, amylase, and protease
Tell your EPI patients to take PERT with meals and snacks.1
When dosing PERTs, consider weight, diet, and symptoms5
According to Cystic Fibrosis Foundation guidelines, enzyme dosing should begin at 500 lipase units/kg/meal for patients ≥4 years of age.
|Patient weight||Minimum dose|
|110 lb (49.9 kg)||24,950 lipase units/meal|
|160 lb (72.6 kg)||36,300 lipase units/meal|
|200 lb (90.7 kg)||45,350 lipase units/meal|
*Always follow the prescribing information of the product you are prescribing for exact dosing information.
of adult PERT patients are started on a dose meant for a PATIENT WEIGHING <100 lb6†
†n=sample of 489,890 PERT patients observed between July 2015 and June 2017; only non-CF patients aged 20+ included; prescribed lipase units per day based on each patient’s average script size over the 2-year study period.
Source: SHS data July 2015-June 2017.
Individualize and titrate PERT dosage based on5,7:
- Clinical symptoms
- Fat content of the diet
Schedule a follow-up visit a few weeks after treatment initiation to discuss symptoms with your patients and assess the need for titration.
Treating EPI with PERT
References: 1. Domínguez-Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep. 2007;9(2):116-122. 2. Fieker A, Philpott J, Armand M. Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol. 2011;4:55-73. 3. Lindkvist B. Diagnosis and treatment of pancreatic exocrine insufficiency. World J Gastroenterol. 2013;19(42):7258-7266. 4. US Food and Drug Administration. Guidance for Industry Exocrine Pancreatic Insufficiency Drug Products – Submitting NDAs. April 2006. https://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm071651.pdf. Accessed October 31, 2018. 5. Cystic Fibrosis Foundation. Use of Pancreatic Enzyme Supplements for Patients with Cystic Fibrosis in the Context of Fibrosing Colonopathy. Paper presented at the: Consensus Conference; March 23, 1995. Accessed August 20, 2018. 6. Data on file. AbbVie Inc. Source: SHS data (2015-2017), 2017. 7. Windsor JA. Pancreatic enzyme replacement therapy in chronic pancreatitis: a long way to go. Gut. 2017;66(8):1354-1355.