Creon (pancrelipase) is a brand-name medication prescribed to treat exocrine pancreatic insufficiency (EPI). This article provides a comprehensive overview of Creon, including its uses, potential side effects, and important considerations for those taking this medication.
What is Creon and What is it Used For?
Creon is a pancreatic enzyme product containing the active ingredient pancrelipase. It is used to treat exocrine pancreatic insufficiency, a condition where the pancreas does not produce enough enzymes to digest food properly. This deficiency can lead to malabsorption of nutrients and various gastrointestinal symptoms. Creon helps replace these digestive enzymes, improving nutrient absorption and reducing symptoms.
Common and Mild Side Effects of Creon
As with any medication, Creon can cause side effects. Many side effects are mild and temporary, lasting a few days to weeks. If these side effects persist, worsen, or become bothersome, it's important to consult a doctor or pharmacist.
Some of the more common and mild side effects reported in clinical trials include:
- Vomiting
- Cough
- Dizziness
- Abdominal pain
- Changes in appearance or frequency of bowel movements
- Common cold symptoms (stuffy or runny nose)
- Gas
- High or low blood sugar
- Irritability
- Low appetite
It's worth noting that the specific side effects and their frequency can vary depending on the condition being treated with Creon. For example, individuals taking Creon for EPI caused by cystic fibrosis may experience different side effects compared to those taking it for EPI due to pancreatitis or pancreatectomy.
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Serious Side Effects of Creon
While most side effects associated with Creon are mild, some serious side effects can occur. If you experience any of the following serious side effects, seek immediate medical attention:
- Possible viral infection: Symptoms can include fatigue, fever, body aches, and feeling generally unwell.
- Fibrosing colonopathy: This rare bowel disorder involves narrowing or scarring of the colon. Symptoms can include sudden, severe abdominal pain, constipation or diarrhea, and blood in the stool.
- Mouth irritation: This can occur if Creon capsules are chewed, crushed, or mixed with acidic foods, leading to discoloration or ulcers in the mouth, and burning or stinging sensations.
- High uric acid level: This can lead to gout (pain, swelling, and discoloration in a joint) or kidney stones.
- Severe allergic reaction: Symptoms can include skin rash, itching, flushing, swelling under the skin (typically in the eyelids, lips, hands, or feet), and swelling of the mouth, tongue, or throat, which can make it hard to breathe.
Side Effect Specifics
Fibrosing Colonopathy
Fibrosing colonopathy is a rare but serious side effect associated with high doses of pancreatic enzymes like Creon, particularly in children with EPI caused by cystic fibrosis. Symptoms include abdominal pain, changes in bowel habits, and blood in the stool. If you notice any of these symptoms, contact your doctor immediately. They may recommend surgery or reduce the dose of Creon. The risk of fibrosing colonopathy may be reduced by following the dosing instructions provided by your healthcare professional.
High Uric Acid Level
Creon contains enzymes derived from the pancreas of pigs, which contain purines. Purines can increase the uric acid level in the body, potentially leading to gout or kidney stones. Symptoms of gout include joint pain, swelling, and stiffness, while kidney stones can cause nausea, painful urination, and blood in the urine. If you have a history of gout, kidney problems, or high uric acid levels, your doctor will likely monitor your uric acid levels closely during Creon treatment.
Mouth Irritation
Creon capsules should be swallowed whole and not chewed, crushed, or mixed with acidic foods. Doing so can damage the protective coating on the capsule and cause irritation in the mouth. If you have difficulty swallowing capsules, you can open them and mix the contents with applesauce. Swallow the mixture immediately and drink water to ensure the entire dose is taken.
Dizziness
Dizziness was a common side effect reported in clinical trials, especially in people taking Creon for EPI caused by cystic fibrosis. If you experience dizziness, avoid driving or operating heavy machinery until you know how Creon affects you. Try moving slowly, especially when changing positions, and lie down and rest until the dizziness passes.
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Allergic Reaction
Although not reported in clinical trials, allergic reactions to Creon are possible. Symptoms can range from mild (skin rash, itching, flushing) to severe (swelling, difficulty breathing). For mild symptoms, contact your doctor immediately. For severe symptoms, call 911 or your local emergency number.
Creon and Weight Changes
Weight changes were not reported as a direct side effect in Creon's clinical trials. However, many conditions affecting the pancreas can cause weight loss due to the body's inability to absorb nutrients properly. Creon helps replace digestive enzymes, which can improve nutrient absorption and potentially lead to weight gain. If you have concerns about weight changes while taking Creon, talk with your doctor.
A 6-month, open-label extension study demonstrated that subjects achieved a mean body weight increase of 2.7 kg while taking Creon.
Fatigue and Creon
Fatigue was not a side effect reported in studies of Creon. However, pancreatic conditions can make it difficult for the body to digest food, leading to vitamin and nutrient deficiencies that can cause fatigue. If you experience fatigue while taking Creon, consult your doctor to rule out any underlying issues.
Creon Dosage and Administration
Creon capsules should be taken with a meal or snack, with enough liquid to swallow them completely. Do not crush or chew the capsules, as this can cause mouth irritation or alter the way the drug works.
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The way in which Creon is intended to be taken is to mimic how pancreatic digestive enzymes are produced in response to food stimuli. When you eat, a process begins through signaling by hormones that enzymes are necessary in order to digest the food. Taking the first capsule with the first bite of food increases it’s availability by the enzymes mixing with the food entering the intestine. Each capsule has a limited amount of enzymes to interact with their respective substrate, i. e., amylase with starches, lipase with lipids/fats, and protease to digest protein. When an individual consumes more starches, fats and protein that exceeds the amount of enzymes available, some food will go partially digested or undigested-thus resulting in losing nutrients and vitamins that could not be absorbed. This is why it is recommended to stagger the taking of multiple capsules during a large meal or when that will stretch over time. Enzymes begin to lose effectiveness as soon as they become activated in the alkaline pH of the small intestine. So it is in one’s best interest to see that there is sufficient enzyme levels available throughout the course of the meal.
Drug Interactions and Precautions
Before taking Creon, inform your doctor about any existing medical conditions, including:
- High uric acid level or gout
- Kidney disease
- Fibrosing colonopathy
- Difficulty swallowing capsules
- Pork allergy
- Previous allergic reaction to Creon
While Creon does not interact with alcohol, drinking alcohol can worsen pancreatic insufficiency, so it's best to avoid alcohol while taking Creon.
Creon During Pregnancy and Breastfeeding
There haven't been any clinical trials of Creon in pregnant people. However, case reports of pregnant people taking Creon have not shown any fetal harm. When you take Creon, most of the drug stays in your digestive tract. Very little of it is absorbed. Talk with your doctor if you are pregnant or plan to become pregnant. They can recommend whether Creon is safe for you.
Creon's effects on children who are breastfed have not been clinically trialed. It's not known whether enough drug is absorbed to pass into breast milk. Talk with your doctor if you have concerns about breastfeeding while taking Creon. They can recommend safe ways to feed your child while taking Creon.
Alternatives to Creon
Several alternatives to Creon are available, both by prescription and over the counter. These include:
- Fungal-Based Enzymes: Made from fungi, these over-the-counter (OTC) enzyme supplements may appeal to people who are avoiding animal products, or those with dietary or religious restrictions. However, there are no prescription fungal enzymes.
- Over-the-Counter Supplements: There are many OTC pancreatic enzymes on the market, including porcine and fungal options. The porcine version may not be enterically coated, making them less effective.
It's important to check with your insurance provider about which enzymes are covered and how much they will pay. No matter which PERT solution you choose, make sure to drink plenty of water while taking enzymes, and if you're taking more than one capsule per meal, space them out to enhance absorption.
Managing Side Effects
During Creon treatment, keep track of any side effects you're experiencing. Share this information with your doctor to help them adjust your treatment plan if needed.
To help relieve gas, you can try:
- Exercising, such as walking or yoga
- Gently massaging your abdominal area
- Avoiding carbonated beverages, such as soda
- Avoiding sugar-free gum, drinks, and candy
- Eating and drinking slowly to avoid taking in too much air
For gas that is painful or doesn't go away, talk with your doctor.