PERT medication are capsules that contain a mixture of digestive enzymes, including lipase to break down fat, protease to assist with digestion of protein, and amylase for carbohydrates, according to the Pancreatic Cancer Action Network (PanCAN). The appropriate dose of PERT varies from person to person, says Stephen Kim, MD, a gastroenterologist with the division of digestive diseases at the David Geffen School of Medicine at UCLA and UCLA Health in Los Angeles. “There are many variables to consider, including residual function of the pancreas, which can worsen over time; the size and fat content of meals; and the goal of PERT for you, whether it’s reducing bloating or eliminating diarrhea,” he says. When you begin PERT, your doctor may start you on a lower dose and then adjust it over time as your therapy is monitored, according to PanCAN. You may also need to take more or less depending on which brand you’re prescribed. “Most people take two capsules with their meal, but sometimes it’s three or more,” says Lawrence Schiller, MD, the former director of the division of gastroenterology at Baylor University Medical Center, which is part of Baylor Scott & White Health in Dallas. “It depends on the product and the concentration.”

  1. Take the medication with a meal. Your first capsule should be taken with the first bite of your meal or snack. If you’re taking multiple enzymes, stagger taking them throughout your meal — not at the end, according to PanCAN. The purpose of PERT is to replace the digestive function of the pancreas, according to the National Pancreas Foundation. “These enzymes work best when taken with a meal, because they help break down complex foods and allow absorption of nutrients,” Dr. Kim says.
  2. Once you take enzymes, don’t delay eating. While pancreatic enzymes are generally safe and well tolerated, taking too much of them can lead to more side effects, including abdominal cramping and nausea, says Kim. Wait until your first bite of food to take your first dose — this way, you won’t need to take more if you end up delaying your meal.
  3. If you miss a dose, don’t double up later on. While you should always take your medication with every meal, don’t take an extra dose with your next meal or snack if you missed one earlier in the day, says Kim. Missing a dose isn’t harmful, but you may experience symptoms such as bloating, flatulence, and diarrhea after you’ve eaten, he says.
  4. Swallow the capsules whole. Chewing the capsules can crush their granules, releasing the enzymes in your mouth or stomach, where acid will destroy them, Schiller says. If you’re unable to swallow the capsules, open them and sprinkle the granules on a fruit puree, such as applesauce. Then swallow the mixture whole — don’t chew — suggests the Cystic Fibrosis Foundation (CFF).
  5. Take smaller doses with snacks. If you’re having a snack or small meal, you may need to take half a dose, according to the CFF. And people with mild EPI may be able to eat small meals or snacks without enzyme supplements. “The dose you’ve taken earlier may have adequate residual pancreatic function,” Kim says. Your doctor can tell you whether you’re able skip a dose if you’re eating a small portion of food.
  6. Store the medication at room temperature. If capsules aren’t stored properly, they can be damaged by heat, according to Penn Medicine’s OncoLink, of the University of Pennsylvania Health System. You don’t need to refrigerate them, but don’t leave your medication in a hot car or near an oven or other heat source.
  7. Keep tabs on all of your meds. Talk to your doctor about PERT and any other pills you take, because they could interact with each other and cause complications. For instance, Kim says that pancreatic enzymes can decrease the absorption of oral iron supplements. It’s also important to tell your doctor if you’re allergic to pork, because most PERT supplements are derived from pig glands, says Kim. Some PERT capsules have a coating that delays release of the enzymes until they reach the small intestines. If the capsules aren’t coated, you may need to take a proton-pump inhibitor (a type of medication that can ward off acid reflux) to prevent the stomach acids in your body from destroying the enzymes before they reach the small intestines, says Kim.

Eat a Healthy Diet for EPI

While taking PERT can allow you to eat a normal diet (as opposed to one that’s particularly low in fat), you should stick to healthy foods whenever possible. It’s recommended that people with EPI eat a diet in which about 30 percent of the total calories come from fat — primarily “good” fats like omega-3 fatty acids, as opposed to trans fats, which are found in many processed goods. Your body needs healthy fat in order to function properly; without it, it can’t absorb certain vitamins, according to the GI Society and its related charity, the Canadian Society for Intestinal Research. Overall, Schiller says that if you eat a healthy diet and take enough enzymes to digest the foods you eat, you won’t have to cut out foods that might cause symptoms or lead to malnutrition without them.