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HIV NUTRITION UPDATE
VOLUME 9, ISSUE 2

By  Stuart Katsh, MS, RD

(Return to page 12)
 
Editor's Note: Medication topics for the MedWatch column are researched by pharmacy interns from Western University of Health Sciences in Pomona, California. Column drafts are reviewed by Research Pharmacist James D. Scott, PharmD, who is an Assistant Professor of Pharmacy Practice at Western University.Columns are finalized into the MedWatch format by Stuart Katsh, MS, RD. The students who co-wrote this issue's article are Susie Yu, PharmDC and Dang Nguyen, PharmDC.
 
Fat malabsorption is one of several causes of diarrhea in HIV-positive patients. It can occur in all patients, regardless of whether or not they are on highly active antiretroviral therapy (HAART). Fecal fat loss can be a contributing factor to weight and nutrient loss in these patients. Pancrelipase products such as Creon® are used to reduce fecal fat loss. One study showed that pancreatic insufficiency is a co-determining factor for malabsorption. In this study, pancreatic enzyme supplementation therapy was highly effective in reducing fecal fat loss in HIV-positive patients with nutrient malabsorption. A literature search for the use of pancreatic enzymes in HIV-positive patients revealed only a few other studies on this topic to date.

Pharmacologic Classification

  •  Digestive Enzyme
Indication
  • Creon® is indicated for the treatment of pancreatic insufficiency because of chronic pancreatitis, pancreatectomy, cystic fibrosis, or gastrointestinal bypass, which leads to inadequate fat and carbohydrate digestion.
  • It is also used for steatorrhea associated with post gastrectomy syndrome and bowel resection to decrease malabsorption.
Dosage Forms
  • Delayed-release Capsules 
  1. Creon5® (5,000 UPS units lipase, 18,750 UPS units protease, 16,600 USP units amylase)
  2. Creon 10® (10,000 UPS units lipase, 37,500 UPS units protease, 33,200 UPS units amylase)
  3. Creon 20® (20,000 USP units lipase, 75,000 USP units protease, 66,400 USP units amylase)
Dosage
  • The dosage is individualized for each patient depending on the severity of malabsorption.
  • The usual starting dose is one capsule per meal or snack for patients at least six years of age.
  • Creon® capsules are taken with meals or snacks.
  • Dosages of more than 6,000 USP units of lipase per kilogram per meal are not recommended.
 

 
 
 
 


 
 
 

 

 
 
 
 
 

Pharmacology and Pharmacokinetics
 
  • Administration reduces the fat and nitrogen content in the stool. Generally, steatorrhea and malabsorption occur only after a 90% or more reduction in secretion of lipase and proteolytic enzymes.
  • Enteric coating prevents the pancreatic enzymes from being destroyed or inactivated in the stomach. Pancreatic enzymes are released in the duodenum and upper jejunum where they catalyze the hydrolysis of fats to glycerol and fatty acids, protein into proteoses and derived substances, and starch into dextrins and short chain sugars.
  • The pancreatic enzymes pass through the gastrointestinal tract and are eliminated in the feces.



 
 
 
 
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11/23/2004