EPI treatment: how to adjust to a strict medication schedule

The pancreas is a gland located between the stomach and the spine. It produces and releases several hormones, including hormones that balance blood sugar and control appetite. It also produces and releases digestive enzymes, which the digestive system needs to break down fats, proteins, and starches.

When a person has exocrine pancreatic insufficiency (EPI), the body does not make enough digestive enzymes. As a result, the body cannot properly digest foods. Symptoms of EPI can include gastrointestinal symptoms, such as gas, bloating, pain, constipation, diarrhea, and fatty bowel movements—uncomfortable symptoms that can have a severe impact on a person’s quality of life.

EPI can also cause malnutrition, and the serious complications that result from malnutrition. These can include fatigue, dry skin, depression, irritability, and problems with memory and concentration. More than half of people living with EPI experience loss of bone density.

In other words, EPI is not a condition to take lightly. The good news is that EPI can be treated with pancreatic enzyme replacement therapy (PERT).

How PERT works

PERT medications contain the enzymes that the body is lacking. By taking these medications with food, a person adds the missing enzymes to the digestion process, helping the body break down and metabolize fats, proteins, and carbohydrates.

This therapy is relatively simple in theory. But it can be difficult in practice, for several reasons:

• PERT medications need to be taken with every single meal and snack, as well as with milky beverages (for example, a latte or a milk-based smoothie). They also need to be taken at certain times during the meal.
• Dosing may also need to be adjusted depending on what you are eating—for example, a meal that contains more fat may need a higher dose.
• EPI often exists alongside other health conditions. This means that many people will be taking other medications as well as PERT medications. When medication schedules feel complicated, they can be more difficult to follow.

5 tips for taking PERT medications

If you find that you are having trouble taking PERT medications, or are taking PERT medications but still experience symptoms, there are strategies that can help.

• Read the instructions carefully. This includes instructions on how to take and how to store your medication. Your healthcare provider and pharmacist can answer any questions you have.
• Plan your meals and snacks for the day. This can help you plan the doses of PERT medications you will need to take ahead of time. It can also help you avoid grazing on snacks.
• Store your medications in the kitchen. This can help you think of them as a part of your meals or snacks. PERT medications should be stored in a dry place at room temperature—so avoid keeping them too close to an oven or stovetop.
• Label the foods in your home that require taking PERT. Include a note about the dosage that each serving requires.
• Measure out your serving sizes. This can help you avoid taking too little PERT for the portion of food you are consuming.

It’s also important to follow a healthy eating plan. Because EPI and health conditions that are associated with EPI can impact your nutritional needs, it can be very beneficial to work with a registered dietitian. At the very least, it’s important to talk to your healthcare providers about the foods that you eat and should be eating.

Your best source of information

Anytime you are having difficulty with a medication or experiencing persistent symptoms, your first strategy is to talk to your healthcare provider.

There is no one-size-fits-all approach to treating EPI. There are different PERT medications available, which contain different dosages of enzymes, and your healthcare provider can help you choose the best option for you. Your healthcare provider can also help you find the right dosage and answer any questions you have on how to take your medication.