Peptizyme

# Peptizyme ## Overview - **Classification**: Pancreatic Enzyme Replacement Product (PERT) - **Mechanism**: Contains exogenous lipase, amylase, and protease to supplement natural pancreatic enzymes, aiding in the digestion of fats, carbohydrates, and proteins in patients with exocrine pancreatic insufficiency. ## Primary Indications 1. **Exocrine Pancreatic Insufficiency (EPI)**: Management of malabsorption due to conditions like cystic fibrosis, chronic pancreatitis, pancreatectomy, or other causes. 2. **Steatorrhea Reduction**: To reduce fatty stools and improve nutrient absorption and growth. ## Adult Dosing ### Standard Dosing **Exocrine Pancreatic Insufficiency (EPI)** - **Dose**: Individualized, typically **500-2,500 lipase units/kg/meal** or **4,000-50,000 lipase units** per meal. - **Frequency**: With each meal and snack. - **Route**: Oral (capsules, often sprinkled on food). - **Maximum Dose**: **10,000 lipase units/kg/day** or **<6,000 lipase units/kg/meal** (to minimize risk of fibrosing colonopathy). Do not exceed **90,000 lipase units/meal**. ### Dose Adjustments - **Renal Impairment**: No specific dose adjustments required. - **Hepatic Impairment**: No specific dose adjustments required. - **Elderly Patients**: Dose based on symptoms and fat intake; no age-specific adjustment needed. ## Pediatric Dosing ### Neonates (0-28 days) - **Dose**: **2,000-2,500 lipase units** per **120 mL formula/breast milk**. - **Frequency**: With each feeding. - **Maximum**: Not weight-based; dose is per feeding volume. - **Special Notes**: Open capsule and mix microspheres with small amount of acidic food (e.g., applesauce) or breast milk/formula (given immediately). Do not mix with milk/formula and let stand. ### Infants (1-12 months) - **Dose**: **2,000-2,500 lipase units** per **120 mL formula/breast milk**. - **Frequency**: With each feeding. - **Maximum**: **2,500 lipase units/kg/meal** or **10,000 lipase units/kg/day**. - **Special Notes**: Microspheres can be sprinkled on acidic soft food (pH < 4.5). Do not crush or chew. ### Children (1-12 years) - **Dose**: **500-2,500 lipase units/kg/meal**. - **Frequency**: With each meal and snack. - **Maximum**: **2,500 lipase units/kg/meal** or **10,000 lipase units/kg/day**, or **<6,000 lipase units/kg/meal** in CF patients. - **Special Notes**: Dose individualized based on malabsorption severity and dietary fat. ### Adolescents (13-18 years) - **Dose**: Initiate with **500 lipase units/kg/meal**; titrate based on clinical response. - **Maximum**: Follow adult maximum doses: **2,500 lipase units/kg/meal** or **10,000 lipase units/kg/day**. ## Safety Information ### Contraindications - **Absolute**: Hypersensitivity to pork proteins (Peptizyme is porcine-derived). - **Absolute**: Acute pancreatitis or acute exacerbations of chronic pancreatitis (until active inflammation subsides). ### Common Adverse Effects - **Very Common (>10%)**: Abdominal pain, flatulence, headache. - **Common (1-10%)**: Nausea, vomiting, diarrhea, constipation, dizziness, hyperglycemia, hypoglycemia. - **Serious but Rare**: Fibrosing colonopathy (with very high doses, especially in CF patients), hypersensitivity reactions (anaphylaxis). ### Key Drug Interactions - **Antacids (e.g., Calcium Carbonate)**: May decrease Peptizyme's effectiveness by altering gastric pH; separate administration. - **Iron Supplements**: High doses may theoretically impair iron absorption; monitor iron levels if concern. - **Acarbose/Miglitol**: Peptizyme may theoretically decrease the effect of alpha-glucosidase inhibitors. ## Monitoring & Follow-up - **Before Treatment**: Baseline weight, nutritional status, stool fat analysis (if available). - **During Treatment**: Assess symptom improvement (e.g., reduced steatorrhea, abdominal pain), weight gain, and nutritional markers. - **Clinical Signs**: Monitor for abdominal pain, changes in bowel habits, or any signs of fibrosing colonopathy (especially in CF patients). ## Clinical Pearls - 💡 **Tip 1**: Administer **with** all meals and snacks to ensure enzymes are present when food enters the small intestine. - 💡 **Tip 2**: Do not crush or chew capsules/microspheres; this inactivates enzymes and can cause oral irritation. - 💡 **Tip 3**: Titrate dose based on clinical symptoms (e.g., stool frequency, consistency, abdominal pain, weight gain) and the fat content of the patient's diet. - 💡 **Tip 4**: For infants, microspheres can be mixed with a small amount of acidic food (pH < 4.5, e.g., applesauce) and given immediately. Avoid mixing with formula/milk and allowing to stand. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.