Alternatives to Pancreaze If You Can't Fill Your Prescription

Pancreaze (pancrelipase) is a critical daily medication for people with exocrine pancreatic insufficiency (EPI). Missing even a few doses can cause rapid nutritional decline — so when your pharmacy can't fill your prescription, you need options fast.

The good news: there are four other FDA-approved pancreatic enzyme replacement therapy (PERT) products in the U.S. that treat the same condition. The important caveat: switching is not as simple as grabbing whatever the pharmacy has — you need your prescriber's involvement to ensure you're getting the right equivalent dose in the alternative product.

This guide covers what alternatives exist, how they compare to Pancreaze, and how to make a safe switch.

Can You Just Substitute Another Pancrelipase Product for Pancreaze?

No — not without a new prescription. Although Creon, Zenpep, Pertzye, Viokace, and Pancreaze all contain pancrelipase (lipase, protease, and amylase from porcine pancreas), they are NOT interchangeable products. The FDA requires a separate prescription for each brand because:

• Each product has different amounts of lipase, protease, and amylase per capsule.
• Different formulations may have different enteric coatings and release profiles.
• Dosing is based on lipase units, and the same number of capsules of different products will NOT give you the same lipase dose.

Contact your prescriber to discuss switching. They can calculate the equivalent lipase dose and write a new prescription specifying the alternative product and strength.

Alternative #1: Creon (Pancrelipase) — AbbVie

Creon is the most widely prescribed PERT in the United States and the most commonly used alternative when Pancreaze is unavailable. Like Pancreaze, Creon contains enteric-coated pancrelipase from porcine pancreas. It comes in six strengths: 3,000, 6,000, 12,000, 24,000, 36,000, and 60,000 lipase units per capsule.

Keep in mind: Creon itself has experienced intermittent supply shortages since 2022, so your local pharmacy may also have gaps in Creon availability. Checking stock at multiple pharmacies — including through medfinder — is important.

Alternative #2: Zenpep (Pancrelipase) — Aimmune Therapeutics

Zenpep is another enteric-coated pancrelipase product approved for EPI treatment in adults and children. It's available in a range of strengths: 3,000, 5,000, 10,000, 15,000, 20,000, 25,000, and 40,000 lipase units per capsule — giving prescribers flexibility in achieving the equivalent dose.

Zenpep works similarly to Pancreaze and is considered clinically equivalent when dosed appropriately by a prescriber. Ask your doctor if Zenpep is covered by your insurance plan, as formulary coverage varies.

Alternative #3: Pertzye (Pancrelipase) — Digestive Care, Inc.

Pertzye is a unique PERT product with a bicarbonate-buffered formulation, which may improve enzyme release in certain patient populations. It's available in strengths of 8,000, 16,000, and 24,000 lipase units per capsule.

Pertzye is FDA-approved for EPI due to cystic fibrosis or other conditions. Your gastroenterologist or CF specialist can advise whether Pertzye's formulation is appropriate for your specific situation.

Alternative #4: Viokace (Pancrelipase) — Aimmune Therapeutics

Viokace is different from the other PERTs in one important way: it is NOT enteric-coated. This makes it suitable for patients who have had surgery affecting gastric acid production (such as a Whipple procedure or gastrectomy), but it must be used alongside a proton pump inhibitor (PPI) to prevent enzyme destruction in the stomach.

Viokace is approved for EPI due to chronic pancreatitis or pancreatectomy, but is generally not the first-line alternative for cystic fibrosis patients. Consult your physician before considering this option.

How Does Dose Conversion Work When Switching?

When switching between PERT products, your doctor will match your total daily lipase units (not capsule count). For example, if you take two Pancreaze 10,500 lipase unit capsules per meal (21,000 lipase units per meal), your doctor might prescribe one Creon 24,000 capsule per meal as an approximate equivalent.

After switching, monitor yourself closely for signs of inadequate enzyme replacement:

• Oily, greasy, or foul-smelling stools (steatorrhea)
• Abdominal bloating or cramping after meals
• Unexplained weight loss
• Increased frequency of bowel movements

Report any of these symptoms to your prescriber promptly so the dose can be adjusted.

What About Insurance Coverage When Switching?

Coverage for alternative PERTs may differ from your Pancreaze coverage. Before switching, call your insurance plan's pharmacy benefit number and ask:

• Is the alternative PERT on my formulary?
• What tier is it, and what will my copay be?
• Is prior authorization required?

If the alternative isn't covered, manufacturer savings cards may help. Creon has a savings card through AbbVie, and Zenpep offers savings programs through Aimmune. Each product's website has information on financial assistance programs.

Finding the Alternative in Stock

Once you have a new prescription for an alternative PERT, you'll still need to confirm it's in stock at a nearby pharmacy. Use medfinder to quickly locate which pharmacies near you carry your new prescription — especially important if you're switching to a less commonly stocked product like Pertzye or Viokace.

Also see our guide to how to save money on Pancreaze for savings card and patient assistance options that can help while you navigate this transition.