PANCRECARB® (pancrelipase) contain buffered pancreatic enzymes: lipase, amylase and protease, isolated and concentrated from porcine pancreatic glands. The enzyme containing microspheres are coated with a pH sensitive enteric-coating to provide protection against gastric inactivation of the buffer-stabilized enzymes during gastric passage.

EACH PANCRECARB® CONTAINS:

	MS-4	MS-8
Lipase	4,000 U.S.P. Units	8,000 U.S.P. Units
Amylase	25,000 U.S.P. Units	40,000 U.S.P. Units
Protease	25,000 U.S.P. Units	45,000 U.S.P. Units

Inactive ingredients include sodium carbonate, sodium bicarbonate, cellulose acetate phthalate, diethyl phthalate, gelatin, sodium carboxymethyl starch, polyvinylpyrrolidone, talc, ursodiol, and other trace ingredients.

Last updated on RxList: 1/20/2009

PANCRECARB® (pancrelipase) Delayed-Release Capsules, Buffered and Enteric-Coated Microspheres are indicated for patients with exocrine pancreatic enzyme insufficiency such as: cystic fibrosis, chronic pancreatitis due to alcohol use or other causes, post-pancreatectomy and post-gastrointestinal bypass surgery (e.g. Billroth II gastroenterostomy).

Dosing, Duration Of Therapy

Dosage should be individualized and adjusted according to fat intake, severity of steatorrhea and the severity of the exocrine pancreatic insufficiency. Begin therapy with one or two capsules with meals or snacks and adjust dosage according to symptoms. Dose increases, if required, should be made slowly, with careful monitoring of response and symptomatology. It is important to ensure adequate hydration of patients at all times while taking PANCRECARB®. Patients with pancreatic enzyme insufficiency should consume a high-caloric diet with unrestricted fat intake, which is appropriate for age and clinical symptomology.

PANCRECARB® (pancrelipase) are supplied as follows:

PANCRECARB® MS-4 (clear, hard gelatin capsule imprinted in blue with "DCI" and "PANCRECARB® MS-4") in bottles of 100 (NDC 59767-002-01).

PANCRECARB® MS-8 (clear, hard gelatin capsule imprinted in blue with "DCI" and "PANCRECARB® MS-8") in bottles of 100 (NDC 59767-001-01).

PANCRECARB® MS-16 (clear, hard gelatin capsule imprinted in blue with "DCI" and "PANCRECARB® MS-16") in bottles of 100 (NDC 59767-003-01).

Storage

Store at controlled room temperature 25ºC (77ºF) in a dry place. Do not refrigerate. Do not expose capsules to humid air. Keep bottle tightly closed. Dispense capsules in a tight container.

Manufacturer information. n/a. FDA rev date: n/a

Last updated on RxList: 1/20/2009

The most frequently reported adverse reactions to pancrelipase-containing products are gastrointestinal in nature, which may include nausea, vomiting, bloating, cramping, constipation or diarrhea. Less frequently, allergic-type reactions have also been observed. Extremely high doses of exogenous pancreatic enzymes have been reported to be associated with hyperuricosuria and hyperuricemia. High strength pancrelipase preparation (i.e., those labeled as containing more than 20,000 lipase units per capsule) has been associated with colonic strictures.

No information provided.

Last updated on RxList: 1/20/2009

Should hypersensitivity occur during the course of treatment, discontinue medication and treat symptomatically. Cases of intestinal stricture and blockage requiring surgical decompression have been reported in cystic fibrosis patients, especially in patients with a history of intestinal complications such as meconium ileus equivalent, short bowel syndrome, surgery or Crohn's disease, who were taking high potency lipase pancreatic enzyme preparations (i.e., those labeled as containing more than 20,000 lipase units per capsule). If symptoms suggestive of gastrointestinal obstruction occur, the possibility of bowel strictures should be considered including the evaluation of pancreatic enzyme therapy. Patients receiving lipase dose of > 2,500 USP units per kilogram per meal should be re-evaluated and the lipase dose either be reduced by 50% or titrated down gradually to the lowest clinically effective dose as determined by 72-hour fecal fat excretion.

GENERAL - TO PROTECT ENTERIC COATING, MICROSPHERES SHOULD NOT BE CRUSHED OR CHEWED.

The microsphere-containing capsules should be swallowed with liquids at the start of a meal. Where swallowing of capsules is difficult, the capsules may be carefully opened and the microspheres shaken into a small quantity of soft food such as applesauce, jelly, jello, etc., which does not require chewing, and swallowed immediately, followed by a glass of water or juice to ensure complete swallowing. Prolonged contact of the microspheres with foods having a pH greater than 5.5 can weaken the integrity of the protective enteric coat and compromise the potency of the enzymes.

Carcinogenesis, Mutagenesis, Impairment of Fertility

Long-term studies in animals have not been performed with PANCRECARB® (pancrelipase) delayed-release capsules.

Pregnancy/Reproduction

Pregnancy Category C. Diethylphthalate, an enteric coating component of PANCRECARB® (pancrelipase) have been shown to be teratogenic in rats following high intraperitoneal dosing. When this coating was given orally to rats up to 100 times the human dose, however, no teratogenic or embryocidal effects were observed.

Last updated on RxList: 1/20/2009

No information provided.

PANCRECARB® (pancrelipase) Delayed-Release Capsules, Buffered and Enteric-Coated Microspheres are contraindicated in patients known to be hypersensitive to pork protein or any other ingredient of this product.

Last updated on RxList: 1/20/2009

The buffer-stabilized pancreatic enzymes in PANCRECARB® (pancrelipase) Delayed-Release are enteric-coated with a gastric acid resistant polymer to protect the enzymes during gastric transit into the duodenum.

After being swallowed, the gelatin capsules dissolve in the gastric juice within minutes and the released microspheres disperse with food in the stomach. Upon passing into the duodenum, the enteric-coated PANCRECARB® microspheres are activated at approximately pH 5.5, discharge their digestive enzymes and the released digestive enzymes help to re-establish the natural digestive conditions in the intestine.

The digestive enzymes in PANCRECARB® act locally in the gastrointestinal tract.

The digestive enzymes hydrolyze fats into glycerol and fatty acids, proteins into peptides and amino acids, and starch into dextrins and maltrose.

Once the digestive enzymes accomplish their catalytic function to hydrolyze food, the digestive enzymes may be inactivated by anti-enzymes which are secreted by the intestinal mucosa or digested by proteases. The digested enzyme fragments may be absorbed from the intestine and subsequently excreted into the urine. The inactivated enzymes are excreted in the feces.

Last updated on RxList: 1/20/2009

Patients Should Be Advised That:

• PANCRECARB® (pancrelipase) should not be crushed or chewed.
• PANCRECARB® (pancrelipase) capsules should be swallowed with liquids at the start of a meal.
• PANCRECARB® (pancrelipase) , when removed from the gelatin capsule, should be swallowed immediately and not retained in the mouth.
• Liquids should be consumed liberally while dosing with PANCRECARB®

Last updated on RxList: 12/8/2004

IMPORTANT NOTE: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your health care professional. Always seek the advice of your health care professional if you have any questions about this product or your medical condition. This information is not intended as individual medical advice and does not substitute for the knowledge and judgment of your health care professional. This information does not contain any assurances that this product is safe, effective, or appropriate for you.

PANCRELIPASE ENTERIC-COATED CAPSULE - ORAL

(pan-kreh-LIP-aze)

COMMON BRAND NAME(S): Creon, Pancrease, Pancron, Protilase, Ultrase, Zymase

USES: This medication contains digestive enzymes to help break down and digest fats, starch, and proteins in food. It is used in conditions where the pancreas cannot make or does not release enough digestive enzymes into the small intestines to digest the food (e.g., chronic pancreatitis, cystic fibrosis, cancer of the pancreas, post-pancreatectomy, post-gastrointestinal bypass surgery).

HOW TO USE: Take this medication by mouth with meals and snacks as directed by your doctor. Swallow the capsule whole. If swallowing is difficult, then the capsule may be opened and the contents mixed in a small amount of liquid or soft food that does not need to be chewed (e.g., applesauce). Do not mix the contents of the capsule with alkaline food or liquid (e.g., milk, ice cream, tea). Consult your doctor or pharmacist for more information about what foods/liquids to avoid when mixing. Swallow the food or liquid right away, making sure not to chew the medication. Drink a glass of water or juice after swallowing the food to make sure all the medication is swallowed. Do not save the medication mixture for later.

Dosage is based on your medical condition, diet, and response to therapy.

Drink plenty of fluids while taking this medication unless your doctor tells you otherwise.

Use this medication regularly to get the most benefit from it. Take it with every meal or snack.

If your doctor has recommended that you follow a special diet, it is very important to follow the diet to get the most benefit from this medication.

Do not change brands or dosage forms of pancrelipase without consulting your doctor or pharmacist. Different products may contain different amounts of the digestive enzymes.

Inform your doctor if your condition persists or worsens.

SIDE EFFECTS: Diarrhea, constipation, abdominal pain/cramps, nausea, or vomiting may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor immediately if any of these rare but very serious side effects occur: severe constipation, severe stomach/abdominal discomfort, frequent/painful urination, joint pain.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching, swelling, severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Contact your doctor for medical advice about side effects. The following numbers do not provide medical advice, but in the US you may report side effects to the Food and Drug Administration (FDA) at 1-800-FDA-1088. In Canada, you may call Health Canada at 1-866-234-2345.

PRECAUTIONS: Before taking pancrelipase, tell your doctor or pharmacist if you are allergic to it; or to pork protein; or if you have any other allergies.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: sudden/severe swelling of the pancreas (acute pancreatitis), sudden worsening of long-term disease of the pancreas.

Before using this medication, tell your doctor or pharmacist your medical history.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is not known whether this drug passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.

This drug should not be used with the following medications because very serious interactions may occur: acarbose, miglitol.

If you are currently using any of these medications listed above, tell your doctor or pharmacist before starting pancrelipase.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US National Poison Hotline at 1-800-222-1222. Canada residents can call a provincial poison control center.

NOTES: Do not share this product with others.

MISSED DOSE: If you miss a dose, take the next dose with your next meal or snack as directed. Do not double the dose to catch up.

STORAGE: Store at room temperature at 77 degrees F (25 degrees C) away from light and moisture. Brief storage between 59-86 degrees F (15-30 degrees C) is permitted. Do not store in the bathroom. Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

Information last revised July 2008 Copyright(c) 2008 First DataBank, Inc.