Pancrease vs. others

Tisha

New member
Hi everybody!

I'm a new user. 25 years old, CF patient, I'll tell you my full story later since it's pretty interesting. I live in Spain, a country where social healthcare (God bless!) gives us all medication for free. But last year Pancrease (20,000x4000x25,000) which I had taken since 1985, stopped being served. "Back order". They said they would have it again at the beginning of this year, but this didn't happen.

When they told me Pancrease wasn't available anymore, it sounded like saying there's no more milk in the stores. I asked what we were supposed to do, and they said everybody had switched to Kreon (8,000x10,000x600) and it worked fine. I was happy for the change, and started taking it. Half the dose, I was told, since it had double as much lipase. "What about the others, amylase and protease?" - "Eh, that doesn't matter, we focus on the lipase". Weird, said I, but ok, let's try this. I tried, and had great stomach aches and diarrhea. Ie, it wasn't working. I called the hospital, and they said "increase the dose, then". Increase it, just like that? Ok then. I did. I started taking just as much Kreon as I had taken Pancrease. No good. The problems were still there. I complained, and was told "Well, not <i>everybody </i>is doing fine. There <i>are </i>actually four other patients that haven't been able to adapt".

The solution was, then, to be given whatever they had still in the pharmacy. It was to expire in December 2005. They gave it all to me... and that's still what I'm taking, now 5 months expired. It's working less strong since it's old, but it kinda works (i have to take more pills).

Finally we've managed to convince the ministry of health in Spain to import some Pancrease from abroad. After a long time, a Pancrease bottle arrived from the Netherlands. Same name, but the stated composition is "5000 U of lipase, 2900 U of amylase and 330 U of protease". I told the pharmacist that was basically half a Kreon capsule, but same proportions, and obviously my body needs the proportions of regular Pancrease. (Why on earth do they make a different medication with the same name??) The ministry replied to us, the measurment was different but this medicine was the very same equivalent. And I have asked them to explain it mathematically, because it defies all logic. No matter if you measure it in units, milligrams or even gallons, if you have 5000 of lipase per 330 of protease, it can never be the same as 5000 of lipase to 25000 of protease!!

I ordered some regular Pancrease from a pharmacy in Israel that ships internationally, and they've just replied it's on back order. It seems the international producer of the basic product which Pancrease is made of, he's out of it, or has stopped making it. I now called the CF Pharmacy in Florida and they tell me regular old Pancrease is not made anymore (it's now MT4, MT 10 and what not, in different proportions), and they're out of Pancrelipase. Ultrase and Lipram seem to be the same, though. But I feel completely lost. They are very expensive (if you take, like me, over 200 pills a month) and I really wonder how you guys in the US make it, to be able to pay for such expensive medications. Not counting on antibiotics, pulmozyme, and all of the other stuff we CF people take.

This is a very long post, sorry for that.
My main question is, what is your experience with pancreatic enzymes? I've always been given it so I never had to choose. Are Lipram and Ultrase good? Any advise? I'll have to get a prescription and buy it somewhere, I guess, but I feel completely lost.

Thanks a million! Best greetings from Spain,

Tisha
 

Emily65Roses

New member
I have no experience with Lipram. Each person is different, but I've been on Ultrase since I was a toddler, and it's always worked very well for me. They had me on Creon when I was a baby, and it did NOT work for me either. I'm currently on Ultrase MT 20s, and they do the trick. If you can't find the stuff that you used to be on, you could give Ultrase a shot. It may work for you, it may not. But it's better than staying on the Kreon, when you KNOW it doesn't work for you.
 

miesl

New member
Discontinued Pancrease units: amylase 20,000; protease 25,000; lipase 4,500.

Pancrease MT-4 units: amylase 12,000; protease 12,000; lipase 4,000.
Pancrease MT-10 units: amylase 30,000; protease 30,000; lipase 10,000.
Pancrease MT-16 units: amylase 48,000; protease 48,000; lipase 16,000.

Creon 5 units: amylase 16,600; protease 18,750; lipase 5,000.
Creon 10 units: amylase 33,200; protease 37,500; lipase 10,000.
Creon 20 units: amylase 66,400; protease 75,000; lipase 20,000.

Ultrase units: amylase 20,000; protease 25,000; lipase 4,500.
Ultrase MT-12 units: amylase 39,000; protease 39,000; lipase 12,000.
Ultrase MT-18 units: amylase 58,500; protease 58,500; lipase 18,000.
Ultrase MT-20 units: amylase 65,000; protease 65,000; lipase 20,000.


It appears that Ultrase would be similar to Pancrease. I've also seen references to Pangestyme and Lipram 4500 delayed release as being similar.
 

Marjolein

New member
We have that problem too. I'm from the Netherlands and we have been having the problem with Pancrease for a year now i think. Sometimes we got some and sometimes we didn't. I heard they safed what they got for the people who really didn't tolerate something else. I switched to Creon and that works for me. I took the 'regular' Pancrease and have the 'regular' Creon now. I used to take 4 pancreases with a meal and take 3 creons. This works. But i know people who would much rather have Pancrease again. We were told the same as you have been told. That they don't have the supplies anymore to make it.

I hope you can find something!
 

Ratatosk

Administrator
Staff member
What about Pancreacarb -- would that be an option? Don't remember off the top of my head, but I thought the amounts were the same? Liza
 

ladybug

New member
Tisha,

I couldn't agree with you more about the discontinuation of pancrease... I've been on it since I was a baby, and was truly devastated when something that helped me keep weight on all these years was now going away. Ugh!

I actually switched to Creon-10 and have done well on them. I don't think I go to the bathroom as much on them, although I seem to have lost a few lbs, which doesn't make sense to me.

I hope you find the answers you seek on here.... Just know you're not alone with this. I don't think anything will ever work as well for me, and I'm very angry they've gotten rid of it.

Good luck!
 

Joanne

New member
Tisha,

It seems that the maker of Pancrease, no longer makes it. My supplier or ordering source can no longer get it, and I had to switch.

I am now on Pancrecarb and love it. No more stomach aches, going to the bathroom if I eat a little bit fatty food. That is a huge plus.

The makers of Pancrecarb are Digestive Care Inc. I am not sure they ship to Spain, but here is the web site and maybe you can talk to someone about it, if you are interested in trying it.

<a target=_blank class=ftalternatingbarlinklarge href="http://www.digestivecare.com/
">http://www.digestivecare.com/
</a>
Good luck
Joanne Schum
luckylungsforjo@aol.com
 

JustDucky

New member
I am sorry you are going through this nightmare....I used to be on Pancrease, but now on Creon 20 and doing well. Have been on Creon for a few months now, I too was worried about the switch...but after a few weeks, I knew that the change would work. But, you keep fighting for your meds....it sucks that you had to go through meds that didn't work for you. I will be thinking of you. Hugs, Jenn
 

Tisha

New member
Thanks to all for your feedback!
I've been also writing to the CF association in Utah, since I'm going to Brigham Young University that's where I "belong" withing the States. I fortunately haven't had to visit them these two years in college, but I wrote and the pharmacist just wrote back and I finally understand what's going on! Here's his letter:


--------------------------------
Tisha,

The old products such as pancrease and ultrase will no longer be
available due to an FDA ruling last fall which gave the enzyme
manufactures 4 years to submit data regarding the safety and
effectiveness of their products as these products were available before
the Safe Food & Drug Act of 1938.

The product that I can see most closely matches would be Pancrecarb
MS-4 (4000lipase 25000protease 25000amylase). You would be getting just
slightly more protease and amylase if you took the same number of
capsules with meals and snacks but I do not think that would make a
dramatic difference.

Another option, is to go with Pancrease MT 4 (4000lipase 12000protease
12000amylase). You could take the same number with meals and snacks and
will not be getting as much protease or amylase but we base our dosing
and dosing changes on lipase.

We would not recommend Lipram as it is a generic manufacturer producing
that product. There seems to be a lot more variability in enzymes
produced by generic manufacturers and they have been associated with
potential problems.

I hope that this all makes sense and feel free to contact me with
questions.

David Young, Pharm.D.
Intermountain Cystic Fibrosis Adult Center Clinical Pharmacist

----------------------------

Well, then I'll meditate - Pancrecarb MS-4 or Pancrease MT4. It actually seems to make more sense to take Pancrease MT4 given that my system reacts to fat in the food, but I'm fine eating carbs and protein even without enzymes (for shorter periods of time, at least).

Anyway, thanks, and have a great day!

Tisha
 
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