11
Pancreatic Enzyme Delivery with Enteral
Nutrition
• There are two FDA-approved options for delivery of pancreatic enzymes
with EN as well as other non-FDA approved anecdotal methods (Table 9).
Advantages and disadvantages of those options are listed in Table 10. Table
12 highlights factors that affect pancreatic enzyme efficacy.
• PERT administration with enteric nutrition requires careful consideration of
the challenges:
▶ Challenge 1: Ensure nurse/caregiver has clear understanding of the process.
▶ Challenge 2: Ensure adequate mixing between PERT and fat content particulary
during long periods of continuous EN infusion.
▶ Challenge 3: Avoid clogging and damage to feeding tubes.
• Novel products as well as creative use of standard enzyme replacement
capsules have been used to overcome these issues.
Table 9A. Three Pancreatic Enzyme Delivery Options for EN
Method 1: FDA-Approved Lipase Cartridge for Continuous Enteral
Feedings
RELiZORB
(Alcresta
erapeutics)
• FDA approved for use in pediatric patients (ages 5 years and
above) and adults
• Lipase mixes with enteral nutrition in the delivery cartridge
NOT the lumen of the GI tract.
• Formulas containing insoluble fiber cannot be used since they
will clog the cartridge. See website for compatible formulas
(https://www.relizorb.com/docs/pdfs/Compatible-Formulas-
and-Pumps.pdf )
• One cartridge is needed for every 500 mL of EN formula.
• Feeding pumps must be set at a flow rate of at least 10 mL/hr
for single cartridge setup and 24 mL/hr in tandem
configuration.
• Maximum flow rate is 120 mL/hr
Method 2: FDA-Approved Delivery of Oral Pancreatic Enzymes for Enteral
Feedings via a Gastrostomy Tube*
Pertzye (4000
USP lipase units
- Digestive Care,
Inc.)
• Pertzye is the only oral pancreatic enzyme with US FDA
approval for gastrostomy (G) tube administration.
http://www.digestivecare.com/PDFs/DCI_G-Tube2017.pdf
• G-tube administration should only be performed with the
contents of one or two 4,000 USP lipase unit capsules.
• Administer with soft foods with a pH of ≤4.0 via a G-tube with
a diameter of ≥14 (e.g., 1–2 capsule contents mixed well in 10
mL applesauce followed by water flush).
• If dose requires more than two capsules, repeat above until
prescribed dose is reached.
* Dose lipase units per Table 7 instructions.
