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How Creon® for Pancreatic Enzyme Replacement Therapy Works

Pancreatic enzyme replacement therapy helps replace necessary digestive enzymes that may be lacking in your system by taking a capsule containing what is known as an enzyme supplement.  The supplement contains a mixture of three necessary pancreatic enzymes.

How does pancreatic enzyme replacement work?

A normally functioning pancreas secretes about 8 cups of pancreatic juice daily. This fluid contains bicarbonate to neutralize stomach acid as well as pancreatic enzymes, which break down the food we consume, including fats, proteins and carbohydrates.

When you take your supplement with food, it goes to your stomach where the capsule breaks down and releases the enzymes. They then mix with your food and activate in your small intestine and help break down the food so your nutrients in the food are absorbed.

What are pancreatic enzymes and what do they do?

There are 3 types of pancreatic enzymes.

  1. Lipase – it works together with bile to break down fat molecules so they can be absorbed and used by the body.
  2. Protease – this enzyme breaks down protein molecules, it also helps to keep the intestine free of parasites.
  3. Amylase – it breaks down carbohydrates (starch) into sugars which are more easily absorbed by the body.

How are pancreatic enzymes taken?

The dosing guidelines for PERT are based on the lipase content of the product. Your doctor will determine the starting dose of pancreatic enzymes replacement either by the grams of fat ingested or, more commonly, by your weight, and calculate the required amount of lipase. The medication should be taken with food, and your doctor will usually recommend a dose to be taken with meals and snacks (e.g. 3 capsules 3 times daily with meals and 1 capsule with snacks).

The most popular pancreatic enzyme replacement is prescription Creon®.

Creon® strengths can be somewhat confusing when you compare the product sold in the US, Canada and the UK. Although they are all sold as brand name Creon®, the exact amounts of the 3 types of enzymes per capsule are not identical. For example, if you were looking for an alternative to Creon® 24,000 sold in the US you will find that it contains 24,000 USP units of lipase (the fat digestive enzyme which is the basis for dosing the medication), as well as 76,000 USP units of protease and 120,000 USP units of amylase.

The closest dosage of Creon® capsules available in the UK contains 25,000 PhEur units of lipase (the key enzyme) plus 18,000 PhEur units of amylase and 1,000 PhEur units of protease.

The closest Canadian Creon® Minimicrospheres version contains 25,000 PhEur units of lipase plus 25,500 PhEur units of amylase and 1,600 PhEur units of protease. 

You will likely have noticed that not only the numbers, but also the units on these products are different.  In the USA, USP standards are used for pancrelipase, while in Europe other standards are used including European Pharmacopoeia (Ph. Eur.)/Fédération Internationale Pharmaceutique (FIP) units. Standardization of lipase units has occurred (1 USP=1 Ph. Eur.=1 FIP unit) but there are differences with regards to amylase and protease unit standards.

If you wanted to go through the calculation yourself, conversion of the units is as follows:

Amylase: 1 Ph. Eur. Unit = 1 BP Unit = 1 FIP Unit 1~4.15 USP Units

Lipase: 1 Ph. Eur. Unit = 1 BP Unit = 1 FIP Unit ~ 1 USP Unit

Protease: 1 Ph. Eur. Unit = 1 BP Unit = 1 FIP Unit ~ 62.5 USP Units

(Sharpe et al. 1997)

You can now see that once the units are converted, while not identical, the three Creon® products are much more similar than it appeared at first glance.

Creon® ingredient strengths in USP Standards Units:

Creon

Lipase

Amylase

Protease

United States

24,000

120,000

76,000

United Kingdom

25,000

74,700

62,500

Canada

25,000

103,750

100,000

Creon® ingredient strengths in European Pharmacopoeia (PhEur) Units:

Creon

Lipase (PhEur Units)

Amylase (PhEur units)

Protease (PhEur Units)

United States

24,000

28916

1216

United Kingdom

25,000

18,000

1,000

Canada

25,000

25,000

1,600

Because the doses are very similar but not exactly the same, in order to substitute the UK or Canadian version of your US Creon your doctor will need to authorize it.  The ingredients are all relatively close and the key ingredient (lipase) is very close in strength across the various countries.  The pharmacy is willing and able to contact your physician to discuss substitution. 

Tips to Remember:

Questions? We are happy to answer your questions about the strengths of the active ingredients in Creon and any other questions you might have.

Further information on Creon  can be found at the following link: Learn More

Need more information? If you have questions about your prescription or any other medication, our discreet and caring team here at Jason’s Canadadrugstore.com will be happy to answer your questions.  Simply phone us Toll Free at 1-800-991-0282

This article contains medical information provided to help you better understand this particular medical condition or process, and may contain information about medication often used as part of a treatment plan prescribed by a doctor.  It is not intended to be used as either a diagnoses or recommendation for treatment of your particular medical situation.  If you are unwell, concerned about your physical or mental state, or are experiencing symptoms you should speak with your doctor or primary health care provider. If you are in medical distress please contact emergency services (such as 911).

Armour® Thyroid Tablets

 Allergan™ distributes Armour® Thyroid (thyroid tablets, USP) in the USA in the following strengths:

The active ingredient (desiccated natural thyroid) in Armour® Thyroid (thyroid tablets, USP) is derived from porcine (pig) thyroid glands.

ERFA® Thyroid Tablets

EFRA™ distributes ERFA® Thyroid (desiccated thyroid) in Canada in strengths of 30mg, 60mg, and 125mg.

EFRA® Thyroid tablets contain desiccated thyroid containing lactose, derived from porcine thyroid glands.

Note that T4 is converted to T3 in your body.

Further information on EFRA  can be found at the following link: Learn More

If you have questions about thyroid medications, please contact our pharmacy Toll Free 1-800-991-0282. We are always happy to answer your questions.

Taking an easy deep breath is something most people take for granted, while for others this natural act is a struggle due to asthma and COPD.

According to the American Lung Association (www.lung.org) there may be as many as 24 million Americans living with Chronic Obstructive Pulmonary Disease, also known as “COPD”.  The COPD Foundation (www.copdfoundation.org) defines COPD as “an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma.”

Symptoms of COPD may vary from person to person, but typical symptoms include wheezing, tightness in the chest, increased shortness of breath and breathlessness, and frequent coughing.  It is also not uncommon for someone with COPD to have other health conditions such as high blood pressure, diabetes, or heart disease.

Most people living with asthma and/or COPD take prescription medication to help manage their condition.  Two of the most common medications are Symbicort and Vannair.

Symbicort

Symbicort is the brand name of an inhaled medication used to treat both asthma and COPD. It contains two active medicinal ingredients: budesonide (a corticosteroid whose job it is to decrease inflammation in the lungs) and formoterol (a long acting beta 2 adrenergic agonist, abbreviated LABA, whose job it is to relax the muscles around the airways to prevent wheezing, cough, chest tightness and shortness of breath).

The Symbicort available in the US is manufactured by Astra Zeneca. It available as an inhalation aerosol, or metered dose inhaler, in two strengths: Symbicort 160/4.5 and Symbicort 80/4.5. These numbers reflect the dose of the two medicinal ingredients delivered from the mouthpiece of the device. In order to deliver this amount from the mouthpiece, the valve of the device (upstream) actually dispenses a total of 200/6 and 100/6.

In other countries – Canada, New Zealand and the United Kingdom – Symbicort is also available as a brand name medication from Astra Zeneca but is marketed differently.

Instead of indicating the amount of active ingredients delivered from the mouthpiece, their labels show the total amount of drugs dispensed from the valve of the device, which is a little higher – 200/6 form the valve is the same as 160/4.5 from the mouthpiece and 100/6 from the valve is the same and 80/4.5 from the mouthpiece. When you read the product monographs for these products, both sets of numbers are explained, but only the total higher dose dispensed from the valve is shown in the product labelling. This may lead to confusion and an incorrect conclusion that they are a higher strength than their US equivalents whereas in fact they are identical.

In the United Kingdom only the higher strength of Symbicort inhaler is available, marketed as Symbicort inhalation aerosol 200/6, which delivers 160/4.5 from the mouthpiece.

In New Zealand, Vannair is the same as Symbicort

In New Zealand, both inhaler strengths are marketed by Astra Zeneca, but under a different brand name –Symbicort. The Symbicort aerosol inhaler 200/6 delivers 160/4.5 from the mouthpiece, while the Vannair aerosol inhaler 100/6 delivers 80/4.5 from the mouthpiece.  These products are not currently available with dose counters.

Symbicort Turbuhaler – Available in Canada, New Zealand and the United Kingdom

To make the Symbicort product even more complicated, it is also marketed as a dry powder inhaler called Turbuhaler in Canada, New Zealand and the United Kingdom. The Symbicort Turbuhaler 200/6 delivers 160/4.5 from the mouthpiece and the Symbicort Turbuhaler 100/6 delivers 80/4.5 from the mouthpiece, making it equivalent to the Symbicort aerosol inhaler in terms of the delivered medication dose. The Turbuhaler is a different delivery system however, which does not dispense an aerosol suspension of the medication but a breath activated dose of dry powder instead. It is important to know that with a Symbicort Turbuhaler, each delivered dose of powder contains lactose as well, which may be of concern for some patients.

The bottom line – Symbicort and Vannair are the same product but with different names in different countries.

In summary, the US Symbicort aerosol inhaler 80/4.5 is the same as the Symbicort aerosol inhaler 100/6 from New Zealand and the US Symbicort inhaler 160/4.5 is the same as the Vannair aerosol inhaler 200/6 from New Zealand or the Symbicort aerosol inhaler 200/6 from the United Kingdom.

Further information on Symbicort and Vannair can be found at the following link: Learn More

If you have questions about these medications, talk to us! Our friendly team here at Canada Online Health is here to answer your questions about this prescription medication for COPD and asthma, and help you find the affordable healthcare solutions you need. Call us Toll Free at 1-800-991-0282 today!

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