Managing
EPI

EPI is a manageable condition1,2

Although Exocrine Pancreatic Insufficiency (EPI) may be a chronic condition, it can be managed. Once an EPI diagnosis has been made, there are a number of things to consider regarding a management plan.

Comprehensive EPI management plan1,3-5

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PERT

  • Pancreatic enzyme replacement therapies (PERTs) are the standard of care for EPI treatment
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Lifestyle modifications

  • Eating a well-balanced diet
  • Avoiding or limiting alcohol intake
  • Smoking cessation
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Vitamin supplements

  • Consider vitamin supplementation, including vitamins A, D, E, and K

PERTs are the standard of care for EPI treatment1,5

PERTs help break down fats, proteins, and carbohydrates so they can be absorbed within the intestines and into the bloodstream.6

PERTs1:

  • Replace pancreatic enzymes in patients with EPI
  • Contain lipase, amylase, and protease

It’s important to remind patients to take PERTs with every meal and snack.3

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Dosing PERTs can start with patient weight7

According to Cystic Fibrosis Foundation guidelines, enzyme dosing should begin at 500 lipase units/kg/meal for patients ≥4 years of age.

Example of weight-based dosing of a PERT7*

Patient weight Minimum dose
110 lb (49.9 kg) 24,950 lipase units/meal
160 lb (72.6 kg) 36,300 lipase units/meal
200 lb (90.7 kg) 45,350 lipase units/meal

*Always follow the prescribing information of the product you are prescribing for exact dosing information.

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36% of adult PERT patients are started on a dose meant for a patient weighing <100 lb8†

†Source: SHS data (2018-2020), 2020. n=sample of 101,612 non-CF PERT patients with at least 1 PERT script present in a given month observed between April 2018 and April 2020; only non-CF patients aged 18+ included; prescribed lipase units per day based on each patient’s average script size over the 2-year study period.

†Source: SHS data (2018-2020), 2020. n=sample of 101,612 non-CF PERT patients with at least 1 PERT script present in a given month observed between April 2018 and April 2020; only non-CF patients aged 18+ included; prescribed lipase units per day based on each patient’s average script size over the 2-year study period.

Individualize and adjust PERT dosage based on7,9:

  • Clinical symptoms
  • Fat content of the diet
  • Degree of steatorrhea

Follow up with patients several days after treatment initiation to discuss symptoms and assess the need for a dose adjustment.7

Get EPI resources

References: 1. Fieker A, Philpott J, Armand M. Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol. 2011;4:55-73. 2. Alkaade S, Vareedayah AA. A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities. Am J Manag Care. 2017;23(12)(suppl):S203-S209. 3. Domínguez-Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep. 2007;9(2):116-122. 4. Lindkvist B. Diagnosis and treatment of pancreatic exocrine insufficiency. World J Gastroenterol. 2013;19(42):7258-7266. 5. Taylor JR, Gardner TB, Waljee AK, DiMagno MJ, Schoenfeld PS. Systematic review: efficacy and safety of pancreatic enzyme supplements for exocrine pancreatic insufficiency. Aliment Pharmacol Ther. 2010;31(1):57-72. doi:10.1111/j.1365-2036.2009.04157.x 6. Pancreatic enzymes. Pancreatic Cancer Action website. https://www.pancan.org/facing-pancreatic-cancer/living-with-pancreatic-cancer/diet-and-nutrition/pancreatic-enzymes/. Accessed December 15, 2020. 7. Use of pancreatic enzyme supplements for patients with cystic fibrosis in the context of fibrosing colonopathy. Cystic Fibrosis Foundation website. https://www.cff.org/uploadedFiles/Content/For_Caregivers/Clinical_Care_Guidelines/Nutrition_and_GI_Clinical_Care_Guidelines/Consensus-Statement-Pancreatic-Enzyme-Replacement-March-1995.pdf. Accessed August 20, 2018. 8. Data on file. AbbVie Inc. Source: SHS data (2018-2020), 2020. 9. Windsor JA. Pancreatic enzyme replacement therapy in chronic pancreatitis: a long way to go. Gut. 2017;66(8):1354-1355.