Creon dosage, forms, and strengths

Creon is a brand-name prescription medication taken with meals that contains pancreas enzymes necessary for the digestion of food. These include enzymes that break down fats (lipases), enzymes that break down proteins (proteases), and enzymes that break down starches into simple sugars (amylases). Healthcare professionals prescribe Creon or other brands of pancreatic enzymes to people whose pancreas is unable to secrete pancreatic enzymes, a condition called exocrine pancreatic insufficiency (EPI). The most common causes of EPI are cystic fibrosis and chronic pancreatitis, but EPI may be due to or associated with other medical conditions such as diabetes (according to a 2023 systematic review), genetic disorders, or surgical removal of part or all of the pancreas (pancreatectomy). 

The generic name of this enzyme mix is pancrelipase, which means “pancreas fat enzymes.” Doses are measured in the number of lipase units in each capsule. This is because fat absorption is the most critical component of EPI treatment. Additionally, healthcare providers can judge the effects of pancreatic enzyme replacement therapy (PERT) by the “coefficient of fat absorption” or CFA. Why is this so important? Fat absorption is the one area that declines the most when the pancreas can’t release enzymes. It also leads to serious vitamin deficiencies. Many crucial vitamins are fat-soluble, including vitamins A, D, E, and K, so the body only absorbs them when it absorbs fats. Supplements containing these fat-soluble vitamins are usually taken along with pancreatic enzymes. 

Creon forms and strengths

Creon and other pancreatic enzyme products are taken as delayed-release capsules. Doses are measured in the number of lipase USP units in each capsule. Protease and amylase units will be proportionately larger or smaller. If the dose of lipase units is doubled, so are the protease and amylase units. So a dose of 3,000 lipase units contains lipase 3,000 USP units, protease 9,500 USP units, and amylase 15,000 USP units. A dose of 6,000 units of lipase also contains 19,000 protease units and 30,000 amylase units.

• Delayed-release capsules: 3,000 lipase units, 6,000 lipase units, 12,000 lipase units, 24,000 lipase units, 36,000 lipase units

Creon dosage for adults

Doses are taken with each meal, not after. A dose of Creon provides sufficient enzymes to digest the contents of one meal. People taking a dose should drink enough fluid to be able to completely swallow the capsule. The prescriber may advise that the dose be split—one part of the dose before the meal and one part during the meal. The prescriber may also advise that half a dose be taken with snacks. In order to take half of a capsule’s dose, the capsule can be opened, and half the contents poured onto applesauce to take.

The size of each dose is based on either the person’s body weight or the amount of fat in the meal. It’s usually easier for patients and clinicians to calculate the dose by body weight. The starting dose will be the lowest possible (500 lipase units per kilogram of body weight), although people with chronic pancreatitis or who have had their pancreas removed may be started at a higher dose. 

After the start of therapy, doses of Creon will gradually increase until the fat content in the stools reaches an acceptable level. It usually takes several days for the body to adjust to a dose, so the entire process of arriving at the optimal dose may take a week or more. 

Creon dosage for children

Creon is FDA approved for use in children as young as infants. As with adults, doses are administered right before feeding or eating. In infants, doses can be given by mixing the capsule contents with a small amount of applesauce which is then placed in the infant’s mouth immediately before feeding, or the capsule contents can be sprinkled directly into the infant’s mouth. Children can swallow capsules whole before meals or snacks. Those who can’t can have the capsule contents mixed in with soft, acidic foods like applesauce.

• Standard Creon pediatric dosage for infants up to 12 months: 3,000 lipase units per 120 ml of formula or for each breastfeeding administered before feeding

• Standard Creon pediatric dosage for children 1 year to 3 years of age: 1,000–2,500 lipase units per kilogram of body weight (2.2 pounds) per meal

• Maximum Creon pediatric dosage for children 1 year to 3 years of age: 2,500 lipase units/kg per meal OR 10,000 lipase units/kg per day OR 4,000 lipase units per gram of fat eaten per day

• Standard Creon pediatric dosage for children 4 years of age or older: Starting dosage, standard dosage, and maximum dosage are the same as for adults

Creon dosage restrictions

Dosage restrictions or precautions are not necessary for Creon. Pancreatic enzymes mostly pass through the digestive system without being absorbed into the bloodstream. People with kidney or liver impairment do not require reduced doses. No dosage reductions are necessary for older adults.

Creon dosage for pets 

Veterinarians do not prescribe Creon for pets, but they will prescribe other pancrelipase products such as Viokase-V, PancrePlus, Pancreved, or Epizyme to pets with exocrine pancreatic insufficiency. Dosage forms include capsules, tablets, or a powder that is mixed in with the pet’s soft food 15 to 30 minutes before mealtime. According to Plumb’s Veterinary Manual, cats generally do not tolerate the taste of pancrelipase powder, so capsules may need to be used instead.

How to take Creon

Creon doses are taken before each meal or snack. They contain the digestive enzymes needed to break down the carbohydrates, proteins, and fats in that particular meal or snack.

• Take this medicine as directed. 

• The doctor will give instructions about how many capsules can be taken in a day. Do not take more than this. 

• The doctor may give special instructions on how to take this medicine.

• This medicine comes with a medication guide. Review it carefully before taking the first dose. If the medication guide is missing, the pharmacist can supply a free copy.

• Always take this medicine with a meal or snack. 

• Swallow the capsule whole with a full glass of water to make sure the capsule is completely swallowed.

• Do not crush or chew the capsule.

• Do not hold the capsule in your mouth.

Infants

• Give the infant a dose immediately before breastfeeding or formula feeding.

• Do not mix the contents of the capsule with the formula or breast milk as this will decrease its effectiveness.

• Open the capsule and either sprinkle the contents in the baby’s mouth or mix the contents with a small amount of acidic food like applesauce. Feed the mixture immediately to the baby. 

• Immediately give the child some liquid to ensure the full dose is swallowed.

• Check the baby’s mouth to make sure the medicine has been swallowed.

Creon dosage FAQs

How long does it take Creon to work?

Creon begins to work immediately to digest fats, proteins, and starches in the meal it is taken with.

How long does Creon stay in your system?

The pancreatic enzymes in Creon are not absorbed into the bloodstream. Instead, they pass through the small intestine and are excreted in stools. The body absorbs very little of these digestive enzymes, so there are few side effects. 

What happens if I miss a dose of Creon?

Pancreatic enzymes only work if they’re taken with a meal or snack. The enzymes need to mix in with the food before they enter or while they are in the stomach. Not taking pancrelipase correctly with a meal will cause problems like malabsorption, abdominal pain, gas, and bloating. If a dose is missed and food is eaten, it’s too late. Do not take the missed dose. Instead, take the next dose with the next scheduled meal. 

How long can you take Creon?

Pancreatic enzyme replacement therapy is usually a lifelong need, especially in people who have had part or all of their pancreas removed. Still, long-term use of digestive enzymes can cause serious side effects, including fibrosing colonopathy in cystic fibrosis patients. Fibrosing colonopathy involves a buildup of scar tissue on the colon’s lining (mucosa) which eventually narrows the colon. Other possible long-term side effects include a possible recurrence of a pre-existing cancer.

How do I stop taking Creon?

Do not stop taking Creon capsules unless told to by a doctor. Creon treatment should not stop unless switching to another source of digestive enzymes. There is one exception, though. Immediately stop taking Creon and call a healthcare professional or get medical help if you experience an allergic reaction such as itching, hives, trouble breathing, facial swelling, or lightheadedness when taking Creon.

What is the maximum dosage for Creon?

Pancrelipase products do not have a standardized maximum dosage. High doses of pancreatic enzymes are not encouraged. Over time, taking high doses of digestive enzymes can cause fibrosing colonopathy and intestinal obstruction. For this reason, the Cystic Fibrosis Foundation Clinical Care Guidelines advise healthcare professionals not to prescribe more than 2,500 lipase units per kilogram of body weight per meal or more than 4,000 lipase units per gram of fat in a meal. Clinicians should only use higher doses if there’s evidence that the current dose is not fixing oily stools (steatorrhea). 

Can you overdose on Creon?

Gastrointestinal symptoms or elevated uric acid levels may occur with taking too much Creon, and it is best to get the advice of the Poison Helpline at 1-800-222-1222 in cases of overdose.

What interacts with Creon?

Creon’s prescribing information lists no known over-the-counter or prescription drug interactions. 

What happens when you mix Creon and alcohol?

There are no reported problems with taking Creon with alcohol. 

Is it safe to take Creon during pregnancy?

The pancreatic enzymes in Creon are barely absorbed into the body. Creon is considered safe to take during pregnancy. While there are no animal or clinical trials, there are no reports of Creon causing problems for a fetus or a pregnancy.

Is it safe to take Creon while breastfeeding?

Healthcare providers consider Creon safe for mothers and their nursing infants. Pancreatic enzymes are barely absorbed into the bloodstream, so they are probably not present in breast milk and don’t affect lactation. 

Who can’t take Creon?

The only contraindications for Creon treatment are allergies to pancrelipase or pig products. Creon is made from porcine pancreas ducts.

What are the side effects of Creon?

Because only very tiny amounts of pancreatic enzymes are absorbed into the bloodstream, the most adverse reactions are digestive system problems like flatulence, frequent bowel movements, nausea, and constipation. People with chronic pancreatitis or who have had their pancreas removed might experience high blood sugar (hyperglycemia) or low blood sugar (hypoglycemia), but this is probably related to how the enzymes digest food. Possible serious side effects include fibrosing colonopathy, intestinal strictures, intestinal obstruction, buildup of uric acid in the blood (hyperuricemia), and severe allergic reactions. 

Sources

• Creon drug summary, Prescriber’s Digital Reference

• Creon HCP, AbbVie Inc

• Creon pancrelipase capsule, delayed release prescribing information NIH National Library of Medicine

• Pancreatic enzymes clinical care guidelines, Cystic Fibrosis Foundation

• Pancrelipase, StatPearls

• What is Creon: Uses, warnings, interactions & FAQs, SingleCare