Zenpep alternatives: What can I take instead of Zenpep?

Compare Zenpep alternatives | Creon | Pancreaze | Pertzye | Viokace | Natural alternatives | How to switch meds

Zenpep (pancrelipase) is a medication approved by the Food and Drug Administration (FDA) to treat pancreatic insufficiency. Pancreatic insufficiency, also known as exocrine pancreatic insufficiency (EPI), is a condition where your pancreas cannot produce the usual enzymes it produces to help us digest food. 

When we eat a meal, our pancreas secretes three main types of digestive enzymes: protease helps us break down and digest proteins in our diet; amylase helps us digest carbohydrates, and lipase helps us break down and absorb fat in our diet. When the pancreas is not working well, these enzymes won’t be produced and secreted in the amount needed to digest our food. 

Symptoms that can be experienced in this situation include diarrhea, bloating, flatulence, nausea, constipation, fatty stools, abdominal pain or cramping, and weight loss. The diarrhea is classically oily when someone has EPI. The most common reasons for the pancreas being unable to secrete these enzymes are cystic fibrosis, chronic pancreatitis, and having part or all of the pancreas removed surgically (pancreatectomy). When taken with meals, Zenpep and other pancreatic replacement enzymes provide the necessary enzymes to break down our food so that it can be absorbed like normal.

What can I take in place of Zenpep?

For various reasons, a patient may need to switch to a different type of pancreatic enzyme replacement therapy. Some patients may not respond to Zenpep in particular. Other patients’ insurance or Medicare drug plans may not cover brand-name Zenpep. Still, others may have side effects to Zenpep. Fortunately, there are several alternative pancreatic enzymes that can be tried. The available pancreas enzymes include Creon, Pancreaze, Pertzye, and Viokace. Ultresa was another pancreas enzyme that has since been discontinued. The generic forms of all these prescription drugs are the same as Zenpep, which is pancrelipase.

Top 4 Zenpep alternatives

1. Creon

Creon is a pancreas enzyme replacement that is indicated for exocrine pancreatic insufficiency (EPI). It comes in four different strengths, starting with a lipase strength of 6K units, up to a maximum of 36K units. Capsules should be taken before or with meals to aid with digestion. Half the normal dose can be taken with snacks. Your doctor will likely recommend a preferred dose, otherwise, you should start with the lowest dose first. The appropriate dose is calculated based on the patient’s weight, usually starting 500 to 2500 units per kilogram with each meal. Rare but serious side effects include allergic reaction, intestinal obstruction, and an inflammation of the colon called fibrosing colonopathy. Common side effects include nausea, headache, diarrhea, and constipation.

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2. Pancreaze

Pancreaze is a pancreas enzyme replacement that is indicated for EPI. It comes in five different strengths, starting with 2.6K units of lipase, up to a maximum of 21K units. Capsules should be taken before or with meals to aid with digestion. Half the normal dose can be taken with snacks. Your doctor will likely recommend a preferred dose, otherwise, you should start with the lowest dose first. The appropriate dose is calculated based on the patient’s weight, usually starting 500 to 2500 units per kilogram with each meal. Rare but serious side effects include allergic reaction, intestinal obstruction, and an inflammation of the colon called fibrosing colonopathy. Common side effects include nausea, headache, diarrhea, and constipation.

3. Pertzye

Pertzye is a pancreas enzyme replacement that is indicated for EPI. It comes in four different strengths, starting with a lipase strength of 4K units, up to a maximum of 24K units. Capsules should be taken before or with meals to aid with digestion. Half the normal dose can be taken with snacks. Your doctor will likely recommend a preferred dose, otherwise, you should start with the lowest dose first. The appropriate dose is calculated based on the patient’s weight, usually starting 500 to 2500 units per kilogram with each meal. Rare but serious side effects include allergic reaction, intestinal obstruction, and an inflammation of the colon called fibrosing colonopathy. Common side effects include nausea, headache, diarrhea, and constipation.

4. Viokace

Viokace is a pancreas enzyme replacement that is indicated for EPI. It comes in two different strengths, with a lipase strength of 10.44K units and 20.88K units. Capsules should be taken before or with meals to aid with digestion. Half the normal dose can be taken with snacks. Your doctor will likely recommend a preferred dose, otherwise you should start with the lowest dose first. The appropriate dose is calculated based on the patient’s weight, usually starting 500 to 2500 units per kilogram with each meal. Rare but serious side effects include allergic reaction, intestinal obstruction, and an inflammation of the colon called fibrosing colonopathy. Common side effects include nausea, headache, diarrhea, and constipation.

Natural alternatives to Zenpep

There are several herbs that can help relieve gastrointestinal symptoms such as bloating, nausea, irregular bowels, and possibly even help with digestion. These herbs include ginger, turmeric, allspice, and bitters such as Gentian, barberry root, and dandelion. Fennel, dill, and caraway have also shown benefits in digestion. That said, none of these herbs or over-the-counter enzyme supplements are likely to replace pancreatic enzyme formulations for someone that has true exocrine pancreatic insufficiency. Always consult with your healthcare provider for medical advice before taking herbs to treat a medical condition.

Any patient with pancreatic insufficiency should be maintained on a low-fat diet, as fats in the diet are the most difficult components of the meal to digest. In addition, strict avoidance of alcohol and smoking are important, as both can cause irritation and fibrosis (scarring) in the pancreas. Maintaining a healthy weight, controlling blood sugars if diabetic, and treating high cholesterol will all help to prevent irritation to the pancreas.

How to switch to a Zenpep alternative

Fortunately, there are several quality pancreatic enzyme products that can substitute for Zenpep. However, there are a couple of important points here. 

One should not stop the Zenpep cold turkey without having an alternative to switch to right away. Once you stop a pancreatic enzyme, the pancreas will not be able to make these enzymes on its own, and so the typical symptoms of pancreatic insufficiency will begin right away (oily stool, diarrhea, bloating, abdominal pain). 

The other important point is that you shouldn’t assume that you can switch to another pancreatic enzyme in a one-to-one fashion. Dosage forms of pancreatic enzymes vary. In other words, just because you are taking one capsule with meals of Zenpep, does not mean you can take one capsule of an alternative and have the same amount of enzymes as you did with Zenpep. The different doses of each brand can be confusing. It is best to check with a healthcare professional for the closest comparable dose of the medication you are switching to. You can also refer to the medication guide for more details on different pancreatic enzyme preparations.

Remember, if you have any questions about switching medications, or if you experience worsening symptoms despite switching, contact your prescribing doctor or gastroenterologist for more health information.