Leigh Ann is receiving pancrelipase (Viokase) for chronic pancreatitis. Which observation best indicates the treatment is effective?
A. There is no skin breakdown.
B. Her appetite improves.
C. She lost more than 10 lbs.
D. Stools are less fatty and decrease in frequency.
Correct Answer: D. Stools are less fatty and decreased in frequency.
Pancrelipase provides the exocrine pancreatic enzyme necessary for proper protein, fat, and carb digestion. With increased fat digestion and absorption, stools become less frequent and normal in appearance. These agents serve as exogenous versions of digestive hormones and enzymes required for normal digestion and are ingested with meals to improve digestion, absorption, and abdominal pain frequently seen in chronic pancreatitis and exocrine pancreatic insufficiency.
Option A: The most common adverse effects are headache, oral irritation, abdominal pain, lymphadenopathy, nasal congestion, and neck pain. Notably, a beta-hemolytic streptococcal infection has been seen with the use of pancrelipase. Rare (less than 1%), but severe side effects include cancer recurrence, anaphylaxis, duodenitis, and distal intestinal obstruction syndrome.
Option B: Patients should take this medication with meals; a general rule of thumb is to take half a dose of pancrelipase with snacks. Most manufacturers recommend beginning with a dose of 500 units of lipase/kg with each meal. Most manufacturers recommend not to exceed 10,000 units of lipase/kg per day.
Option C: Warnings include fibrosing colonopathy (especially when doses exceed 2500 lipase units/kg of body weight per meal or greater than 10,000 lipase units/kg of body weight per day) and hyperuricemia as porcine-derived pancreatic enzyme products contain purines that may increase blood uric acid levels.
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