PERTs are pancreatic enzyme preparations consisting of pancrelipase, an extract containing multiple animal-derived enzyme classes, including lipases, proteases, and amylases.1 PERT is the cornerstone of treatment for EPI.2
PERT preparations contain a combination of porcine-derived lipases, proteases, and amylases3.
PERT is orally administered as capsules or tablets and is taken during meals or snacks, with sufficient fluid.1,2 PERT should be swallowed whole and should not be crushed or chewed.
The pancreatic enzymes in PERTs catalyze the hydrolysis of fats to glycerol and free fatty acids, proteins into peptides and amino acids, and starches into dextrins and short chain sugars in the duodenum and proximal small intestine, thereby acting like digestive enzymes physiologically secreted by the pancreas.
PERT may be dosed based on fat ingestion or actual body weight. The initial starting dose and increases in the dose should be individualized based on clinical symptoms, the degree of steatorrhea present, and the fat content of the diet.
In children > 4 years and in adults, enzyme dosing should begin with 500 lipase units/kg of body weight per meal to a maximum of 2,500 lipase units/kg of body weight per meal (or < 10,000 lipase units/kg of body weight per day), or less than 4,000 lipase units/g fat ingested per day.
Usually, half of the prescribed dose for an individualized full meal should be given with each snack.