How Many Enzymes Are Too Many?

[tracy]

My eight year old daughter has always needed enzymes but they've worked really well for her- she's over 50th %tile height and weight. She's 27 kg and takes 6 to 7 Creon 20s for dinner and lunch, 5 for breakfast and 1 for snacks. Everything is working well but the docs think this is too many enzymes so they want tostart her on antacids. We hate to give her yet another drug without investigating alternatives and also because she feels fine (no reflux, no constipation, no abdominal pain) so we are reluctant to change her regimen. Does anyone have any thoughts on this issue. Have you had to make this change yourselves and how did it go? Is this a lot more enzymes than others are taking?

Thanks for your input!

Tracy

 

[JazzysMom]

Did the doctor give an actual reason for wanting to change things? I have adjusted my enzymes according to what I ate, but other then that I didnt need to change anything. Interesting to know why the change? The antacids help enzymes work better!

 

[Emily65Roses]

I take 5 with meals. Though it seems like a bit much, 6 or 7 isn't bad. I say don't change it if there's nothing wrong. Like Melissa said, see if there's some real reason they want to change it before you allow it.

But I might add that she may need an antacid someday anyway. A LOT of CFers get acid reflux. It is another med, and it's a pain, but it does <i><b>wonders</i></b>.

I go back to what I said before, though. Unless there's an actual reason to change her enzymes, I don't see why you would.

 

[becca23]

I currently take 10 Creon 20 and Prilosec otc twice aday.

I was put on the prilosec for many reasons, acid reflux and also it helps slow down the absorption of food therfore allowing the creon to work. I was having lots of trouble with bowel obstructions.

 

[Mockingbird]

I forget why, but there is a medical reason the docs don't want us taking too many enzymes. I only take 5 Creon 20 for meals, 3-4 for snacks, and my doctor says I don't want to be taking any more than that.

The term "antacid" is kinda misleading, because if you search around you will find antacids can neutralize oral anti-biotics (It is because of the magnesium in them) What the doctors actually prescribe is proton-pump inhibitors (Prilosec, pepsid, etc.)or H2 blockers (zantac). They are different because they prevent the stomach from producing acid in the first place, instead of just neutralizing the acid in the stomach, and they don't affect antibiotics.

Anway, I started taking zantac before I had any symptoms of reflux and it improved the efficiency of my enzymes. Since then I have developed acid reflux, so now I take prilosec, or something (omeprazole, whatever that's generic for).

Anyway, i say go for it. There's very little risk, as far as I know, and much benefit.

 

[kybert]

i highly recommend putting your daughter on the acid meds. she is on way too many enzymes for her age and weight! that dosage is considered too much for a grown adult so you can imagine what it would be like for a child. the meds mockingbird mention really do work and like everyone said, she will probably need them down the track anyway.

ok i found this
<div class="FTQUOTE"><begin quote>The recommended dose (Editor's Note: predates publication cited above) for digestive enzymes is 1500 to 3000 Units of lipase per kilogram of body weight per meal. Doses above 6000 Units of lipase per kilogram meal, (or 4.5 MT-24 capsules per meal) have been associated with colonic stricture: the ascending colon becomes blocked, sometimes requiring a surgical solution.</end quote></div>
so that would mean 8 creon 20's per meal is a dangerous amount. shes on 7 for dinner. thats very close. i certainly wouldnt risk it...

 

[anonymous]

our dr. says you should take on an average day, one creon per kilo of bodyweight my son is 23 kilos and it does work out on average 23 creon a day. he is very skinny, partly because he is so active and also my family are all skinny as children . ( not as adults unfortunately<img src="i/expressions/face-icon-small-happy.gif" border="0">) hope that helps. ps that is in the uk, all countries have different advice. did you know in sweden all people with cf go into hosp. twice yearly for iv whether ill or not. my dr. told me that when i was moaning about my son having to go into hosp. for a fortnight.

 

[kybert]

anon, that depends on the strength of creon. it sounds like your son is on creon 5's or 10's, where one tablet per kilo of body weight would be justifiable. creon 20 on the other hand, you wouldnt want to take one tablet per kilo of bodyweight unless you had a deathwish!

p.s. if he doesnt like taking so many tablets you can always switch to a higher strength and cut the amount in half. there is no need to have to take 23 tablets unless you are an adult on the highest strength with an unusual need for alot of enzymes.
eg. 23 creon 5's per day = 11 or 12 creon 10's. same goes with creon 10 compared to creon 20. [note that creon <b>forte</b> has 25000 whateveritis of lipase in it, so 23 tablets of creon 10's would equal 9 tablets of creon forte].

 

[anonymous]

hi . just looked at bottle of creon , he takes creon10000. doesn't seem to mind taking that many . he's a good lad considering what he puts up with.<img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[anonymous]

Tracy,
My daughter is also 8 years old, and she takes only 4 Ultrase MT20's with her meals. I have a 6 year old daughter who only takes 3 with meals.

My 8 year old takes Prilosec twice per day, one in the am and one in the pm. She never has had a problem with reflux, and weight wise she has always been just under the 50%. But as others say, it does help with absorbtion of the enzymes. It is common for those with CF to have a lot of acid in there! She was only on one a day until about 2 months ago, when each morning she was waking up with stomach aches and her weight had stayed steady with no gain for about 6 months. All we did was add a dose of Prilosec in the evening, and the morning stomach aches went a way, and she started gaining weight again!! We didn't change enzyme dosage at all, just adding prilosec. Her CF clinic says that she is at the max amount of enzymes that they feel comfortable giving her.

My 6 year old did suffer from reflux as a baby, but still only needs one Prilosec each day, in the morning. She too stays just under the 50% in her weight.

I would definately consider it, and back off on the enzymes dosage if possible. And there is really no change to make, it just simply replacing an enzyme with a Prilosec. We take the generic Prilosec, and both girls do great with it.

Good luck!

 

[tracy]

Thanks for your response, thanks for everyone's responses! Is there any downside to taking prilosec? Can one ever get off it once its started?

Tracy

 

[anonymous]

We have had no problems at all with the prilosec what so ever. And yes, they can get off of it if not needed. I was questioning as to whether it was really all that important that my 6 year old be on it because she had no signs of reflux any more (this was a few years ago, she was about 4 at the time) so the CF doc agreed to try to take her off of it. He agreed that she need not take something if it is not necessary. But within a few months her weight started to drop. We added back the one prilosec a day, and it the weight came right back up!

 

[anonymous]

hi, My daughter was just put on creon 20 and she gets 3 with meals and snacks she is 9 and weighs 74lbs. She used to be really little. She also takes prilosec twice a day. She used to be on ultrase mt12 5 with meals and snacks. We just switched her and her brother's enzymes due to insurance reasons. My copay for ultrase was going to be close to $900 a month just for there enzymes. Ouch couldn't do that so we switched them to creon out insurance covers them at $30 each much better than $900. My son is on prilosec and he is 5 and just hit 40 lbs he does have a g-tube. I was told that they go by weight and age to determine the dose. I go to St Louis Childrens Hospitals cf center it's great.

Mother to 3 wonderful children 2 dx with cf in 2002 and one with out cf she is 2 years old

 

[anonymous]

We, too, go to St. Louis Childrens Hospital. They are great there! And I was told the same thing, it goes by weight as to how many enzymes they can be given, but that the Prilosec makes a big difference. It is great to see how well your children are doing weight wise. Sounds like your son has had to fight to get his weight up since he is on a g-tube.

 

[anonymous]

Here is a link to a useful pdf that has info on using antacids, enzyme dosage, etc:
<a target=_blank class=ftalternatingbarlinklarge href="http://www.healthsystem.virginia.edu/internet/digestive-health/nutritionarticles/goodinarticle.pdf
">http://www.healthsystem.virgin...les/goodinarticle.pdf
</a>
It may take a while to load but is very interesting.

My daughter is 3 wcf and takes Prevacid once a day. She does not have reflux and takes only about half of her allowed max enzymes (according to her weight) but she is constantly battling constipation so we are trying Prevacid to see if that helps make the enzymes more effective. She has been on it for a month now and her stools are better but still not great.

Hope this helps!

 

[CFHockeyMom]

Hi Tracy,

6 to 7 enzymes seems like a lot for only 27kg. Sean takes 3 and he's ~24kg. We asked about increasing his enzymes a bit because he's been experiencing a lot of stomach pain lately but the Dr. prescribed Zantac instead. She said he was already on the borderline of his enzyme dose.