When Creon Isn't Available, You Still Have Options

If you depend on Creon (Pancrelipase) to help you digest food, hearing that your pharmacy is out of stock can feel alarming. Creon isn't a "nice to have" medication — it's essential for people whose pancreas doesn't produce enough digestive enzymes. Without it, you can experience severe bloating, diarrhea, malnutrition, and dangerous weight loss.

But here's the reassuring news: Creon isn't the only pancreatic enzyme replacement therapy (PERT) on the market. Several FDA-approved alternatives contain the same types of enzymes and treat the same condition. This article will walk you through what those alternatives are, how they compare, and what to discuss with your doctor.

What Is Creon and How Does It Work?

Creon is a prescription medication made by AbbVie that contains three digestive enzymes derived from porcine (pig) pancreas:

• Lipase — breaks down fats
• Protease — breaks down proteins
• Amylase — breaks down carbohydrates

These enzymes are packaged in delayed-release capsules containing enteric-coated microspheres. The enteric coating protects the enzymes from stomach acid, allowing them to reach the small intestine where they do their work.

Creon is prescribed for exocrine pancreatic insufficiency (EPI) caused by cystic fibrosis, chronic pancreatitis, pancreatic surgery, pancreatic cancer, and other conditions. For a more detailed explanation, see our article on how Creon works.

You take Creon with every meal and snack. The dose depends on your weight, how much fat you eat, and the severity of your EPI. For complete dosing information, check our guide on Creon uses and dosage.

FDA-Approved Alternatives to Creon

All of the alternatives listed below are FDA-approved pancreatic enzyme replacement therapies. Like Creon, they are porcine-derived and contain lipase, protease, and amylase. However, they are not generic equivalents — each is a separate branded product with its own formulation, and switching requires a new prescription from your doctor.

1. Zenpep (Pancrelipase)

Manufacturer: Organon

Zenpep is one of the most commonly prescribed alternatives to Creon. It's available in a wide range of strengths (3,000 to 40,000 lipase units), giving doctors flexibility in dosing. Like Creon, Zenpep uses delayed-release capsules with enteric-coated beads.

Key differences from Creon:

• Available in a 40,000 lipase unit capsule (Creon's highest is 36,000)
• Different microsphere size and coating may affect some patients differently
• Similar pricing — typically $700–$1,400/month cash price

Zenpep is FDA-approved for EPI due to cystic fibrosis and other causes. It has its own manufacturer savings program for eligible patients.

2. Pancreaze (Pancrelipase)

Manufacturer: Vivus/Johnson & Johnson

Pancreaze is another delayed-release capsule formulation available in multiple strengths (4,200 to 21,000 lipase units). It's a solid alternative for patients who can't access Creon.

Key differences from Creon:

• Strength options differ from Creon — your doctor will need to calculate an equivalent dose
• Available in strengths not offered by Creon (e.g., 4,200 and 10,500 units)
• May have different availability patterns than Creon

3. Pertzye (Pancrelipase)

Manufacturer: Chiesi USA

Pertzye stands out among PERT products because it contains bicarbonate in addition to the standard lipase, protease, and amylase enzymes. The bicarbonate helps create a more favorable pH environment in the small intestine, which may help the enzymes work more effectively for some patients.

Key differences from Creon:

• Contains bicarbonate buffering — unique among PERT products
• Available in 8,000 and 16,000 lipase unit capsules
• May be preferred for patients with very acidic digestive environments

4. Viokace (Pancrelipase)

Manufacturer: Bausch Health

Viokace is different from the others in an important way: it is a non-enteric-coated tablet. Because it lacks enteric coating, it must be taken with a proton pump inhibitor (PPI) to prevent stomach acid from destroying the enzymes before they reach the small intestine.

Key differences from Creon:

• Tablet form, not capsule — no enteric coating
• Must be taken with a PPI (like Omeprazole or Pantoprazole)
• FDA-approved only for chronic pancreatitis and pancreatectomy — not for cystic fibrosis
• Available in 10,440 and 20,880 lipase unit tablets

Viokace is not appropriate for all Creon patients, particularly those with cystic fibrosis. Discuss with your doctor whether this option makes sense for you.

How to Switch from Creon to an Alternative

Switching between pancreatic enzyme products is not something you should do on your own. Here's the right process:

1. Talk to your doctor. Explain that you're having trouble finding Creon and ask about alternatives.
2. Get a new prescription. Your doctor will need to write a new prescription for the alternative product, with dosing adjusted for the specific enzyme units in that formulation.
3. Check availability. Use Medfinder to see if the alternative is in stock near you before committing to the switch.
4. Monitor your symptoms. After switching, pay attention to how you feel. Some patients may need dose adjustments when changing PERT products.

Your doctor may also want to check your fecal elastase levels or other markers to ensure the new product is working effectively for you.

What About Over-the-Counter Enzyme Supplements?

You may have seen over-the-counter digestive enzyme supplements at the drugstore. These are not substitutes for prescription PERT products like Creon. OTC enzymes are dietary supplements that are not FDA-regulated for potency or consistency. They contain far lower amounts of lipase than prescription products and are not appropriate for treating EPI.

If you have exocrine pancreatic insufficiency, you need a prescription-strength enzyme product. Never substitute an OTC supplement without talking to your doctor.

Final Thoughts

Creon is the most widely prescribed pancreatic enzyme replacement therapy, but it's not your only option. Zenpep, Pancreaze, Pertzye, and Viokace are all FDA-approved alternatives that can help manage exocrine pancreatic insufficiency when Creon isn't available.

Start by using Medfinder to check if Creon or any of these alternatives are available at pharmacies near you. If you need to make a switch, work closely with your doctor to find the right product and dose. And for tips on managing the cost of these medications, check out our guide on how to save money on Creon.