BNF for Children (BNFC) 2018-2019

Non-drug treatment

gDietary advice should be provided. Food intake should

be distributed between three main meals per day, and two or

three snacks. Food that is difficult to digest should be

avoided, such as legumes (peas, beans, lentils) and high-fibre

foods. Alcohol should be avoided completely. Reduced fat

diets are not recommended.h

Medium-chain triglycerides (see MCT oil, inBorderline

substances), which are directly absorbed by the intestinal

mucosa, were thought to be useful in some children.

However evidence has shown that MCT-enriched

preparations offer no advantage over a normal balanced diet.

PANCREATIC ENZYMES

Pancreatin 08-Mar-2017

lDRUG ACTIONSupplements of pancreatin are given to

compensate for reduced or absent exocrine secretion. They

assist the digestion of starch, fat, and protein.

lINDICATIONS AND DOSE

CREON® 10000

Pancreatic insufficiency

▶BY MOUTH

▶Child:Initially 1 – 2 capsules, dose to be taken with each

meal either taken whole or contents mixed with acidic

fluid or soft food (then swallowed immediately without

chewing)

CREON® 25000

Pancreatic insufficiency

▶BY MOUTH

▶Child 2–17 years:Initially 1 – 2 capsules, dose to be taken

with each meal either taken whole or contents mixed

with acidicfluid or soft food (then swallowed

immediately without chewing)

CREON® 40000

Pancreatic insufficiency

▶BY MOUTH

▶Child 2–17 years:Initially 1 – 2 capsules, dose to be taken

with each meal either taken whole or contents mixed

with acidicfluid or soft food (then swallowed

immediately without chewing)

CREON®MICRO

Pancreatic insufficiency

▶BY MOUTH

▶Neonate:Initially 100 mg, for administration advice, see

Directions for administration.

▶Child:Initially 100 mg, for administration advice, see

Directions for administration

DOSE EQUIVALENCE AND CONVERSION

▶ForCreon®Micro: 100 mg granules = one measured

scoopful (scoop supplied with product).

NUTRIZYM 22®GASTRO-RESISTANT CAPSULES

Pancreatic insufficiency

▶BY MOUTH

▶Child 15–17 years:Initially 1 – 2 capsules, dose to be

taken with meals and 1 capsule as required, dose to be

taken with snacks, doses should be swallowed whole or

contents taken with water, or mixed with acidicfluid or

soft food (then swallowed immediately without

chewing)

PANCREASE HL®

Pancreatic insufficiency

▶BY MOUTH

▶Child 15–17 years:Initially 1 – 2 capsules, dose to be

taken during each meal and 1 capsule, to be taken with

snacks, all doses either taken whole or contents mixed

with slightly acidic liquid or soft food (then swallowed

immediately without chewing)

PANCREX®

Pancreatic insufficiency

▶BY MOUTH

▶Child 2–17 years: 5 – 10 g, to be taken just before meals,

washed down or mixed with milk or water

PANCREX®V

Pancreatic insufficiency

▶BY MOUTH

▶Child 1–11 months: 1 – 2 capsules, contents of capsule to

be mixed with feeds

▶Child 1–17 years: 2 – 6 capsules, dose to be taken with

each meal either swallowed whole or sprinkled on food

PANCREX®VCAPSULES’ 125 ’

Pancreatic insufficiency

▶BY MOUTH

▶Neonate: 1 – 2 capsules, contents of capsule to be given in

each feed (or mixed with feed and given by spoon).

PANCREX®VPOWDER

Pancreatic insufficiency

▶BY MOUTH

▶Neonate: 250 – 500 mg, dose to be taken with each feed.

▶Child: 0. 5 – 2 g, to be taken before or with meals, washed

down or mixed with milk or water

PANCREX®VTABLETS

Pancreatic insufficiency

▶BY MOUTH

▶Child 2–17 years: 5 – 15 tablets, to be taken before meals

PANCREX®VTABLETSFORTE

Pancreatic insufficiency

▶BY MOUTH

▶Child 2–17 years: 6 – 10 tablets, to be taken before meals

lCONTRA-INDICATIONS

NUTRIZYM 22®GASTRO-RESISTANT CAPSULESShould not

be used in children aged 15 years or less with cysticfibrosis

PANCREASE HL®Should not be used in children aged

15 years or less with cysticfibrosis

lCAUTIONSCan irritate the perioral skin and buccal mucosa

if retained in the mouth.excessive doses can cause

perianal irritation

lINTERACTIONS→Appendix 1 : pancreatin

lSIDE-EFFECTS

▶Common or very commonAbdominal distension.

constipation.nausea.vomiting

▶UncommonSkin reactions

▶Frequency not knownFibrosing colonopathy

lPREGNANCYNot known to be harmful.

lDIRECTIONS FOR ADMINISTRATIONPancreatin is

inactivated by gastric acid therefore manufacturer advises

pancreatin preparations are best taken with food (or

immediately before or after food). Since pancreatin is

inactivated by heat, excessive heat should be avoided if

preparations are mixed with liquids or food; manufacturer

advises the resulting mixtures should not be kept for more

than one hour and any left-over food or liquid containing

pancreatin should be discarded. Enteric-coated

preparations deliver a higher enzyme concentration in the

duodenum (provided the capsule contents are swallowed

whole without chewing). Manufacturer advises gastro-

resistant granules should be mixed with slightly acidic soft

food or liquid such as apple juice, and then swallowed

immediately without chewing. Capsules containing

enteric-coated granules can be opened and the granules

72 Reduced exocrine secretions BNFC 2018 – 2019

Gastro-intestinal system

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