UPDATE: Pancreatic Enzyme Replacement Therapy (PERT) supply problems

16th April 2024


You might have noticed supply issues with pancreatic enzyme replacement therapy (PERT), sometimes also called pancreatin. This situation has progressed. It has now caused some people who need PERT to run out of it. These medicines are supplied under the brand names Creon®, Nutrizym®, and Pancrex®. This advice is taken from a position paper written by dietitians and supported by doctors and charities who support people needing PERT. You can find a copy of this here: Position Statement: Pert Shortage | Pancreatic Society of Great Britain and Ireland (psgbi.org). If you would like a printed copy, you can e-mail us: info@gutscharity.org.uk or call us: 020 7486 0341. This information will help you to reduce the impact of the shortage on your symptoms and quality of life. 

Doctors prescribe PERT. It helps digestion in people with pancreatic exocrine insufficiency (PEI). It is most often needed due to pancreatitis, pancreatic cancer, and cystic fibrosis (CF). Several other medical situations may cause PEI. These are called secondary causes.  

These include:   

  • Type 3c diabetes 
  • Gastrectomy – surgery to remove the stomach.  
  • Gastric bypass surgery 

The types of symptoms and their severity will vary from person to person. Symptoms do not depend on the cause of the insufficiency.  

Symptoms of untreated PEI may include:  

  • Bloating 
  • Excess wind.
  • Diarrhoea. 
  • Crampy abdominal pain. 
  • Urgency to open bowels. 
  • Steatorrhea (pale floating poo). 
  • Hard to manage blood glucose levels.  
  • Vitamin and mineral deficiencies. 
  • Weight loss and malnutrition. 

These symptoms are usually treated by taking PERT. They will come back if you can’t take enough. Not having these symptoms does not mean you do not have PEI. Some people have PEI without symptoms.  

The advice in this leaflet may be updated. It will be updated if there is more guidance. Also, if there is more experience of managing PEI without enough PERT 

Please note the advice in this document is designed for adults with PEI. Specialist advice should be sought for children with PEI. 

People with cystic fibrosis (CF) will be under the care of a specialist centre.  The Cystic Fibrosis Trust have produced specific information for people with CF. Some of the information in this leaflet is not suitable for people with CF. Please contact your specialist team for advice. 

A person writing on a clipboard in hospital

The advice for patients has been split into 4 stages.   

Stage 1 – There are supplies available.  

Stage 2 – There are limited supplies available.  

Stage 3 – There are not enough supplies, and you have abdominal (belly) symptoms. (See above)  

Stage 4 – There are no supplies available.  

PERT is still being delivered regularly into the United Kingdom. So, people will move backwards and forwards between these stages. It is not expected for people to completely run out of PERT for long. So, if we do have to use the advice in phase 3 or 4, it is thought that this will only be for a short period of time. 


Whilst PERT supply issues continue, please do not stockpile them. Stockpiling will further drive the shortage. 

The Department of Health and Social Care has recommended that only 1-month supply is issued at a time. This is to try and regulate supplies. So, if you currently receive 2-3 months of your PERT at a time, you will need to collect your prescriptions more often. If you pay for your prescription, consider applying for a pre-payment certificate here. This will help to reduce the cost of prescription charges.

You should place your prescription requests earlier. Do so 2 weeks in advance. This is to give the local pharmacist time to source your medication. 

If what you usually take is not available, you may need a change in your repeat prescriptions to another brand. Three brands of PERT are available in the UK. They are Creon®, Nutrizym®, and Pancrex®. 

Remember to store your PERT appropriately. All PERT should be stored below 25 degrees. Some brands recommend refrigeration, check the packaging. If PERT gets too hot it does not work properly, this damage cannot be reversed. 

Taking the PERT throughout the meal is the best way. Rather than all at the start/ middle/ end of the meal. This is because it improves how well it digests what you are eating. 

Ensure that you use your PERT before it goes out of date. If you store PERT in different places (i.e. at work), rotate your supplies to prevent waste. 

Table 1 shows how each enzyme product compares to others:

Table 1: Conversion charts (2) Creon® 25,000 Dose   Equivalent in Nutrizym® 22   Equivalent in Creon® 10,000   Equivalent in Pancrex® 340mg (8,000 units lipase)   Equivalent in Pancrex® 125mg (2,950 units lipase)   Equivalent in Creon® Micro*   Pancrex® V powder*  
1 x Creon 25,000   1 x Nutrizym 22   3 x Creon 10,000   3 x Pancrex 8,000   8 x Pancrex 2,950   5 scoops Creon Micro   ½ x 2.5ml spoon  
2 x Creon 25,000   2 x Nutrizym 22   5 x Creon 10,000   6 x Pancrex 8,000   16 x Pancrex 2,950   10 scoops Creon Micro   1 x 2.5ml spoon  
3 x Creon 25,000   3 x Nutrizym 22   8 x Creon 10,000   9 x Pancrex 8,000   24 x Pancrex 2,950   15 scoops Creon Micro   1½ x 2.5ml spoon  
4 x Creon 25,000   4 x Nutrizym 22   10 x Creon 10,000   12 x Pancrex 8,000   32 x Pancrex 2,950   20 scoops Creon Micro   2 x 2.5ml spoon  
5 x Creon 25,000   5 x Nutrizym 22   13 x Creon 10,000   15 x Pancrex 8,000   40 x Pancrex 2,950   25 scoops Creon Micro   2 ½ x 2.5ml spoon  
6 x Creon 25,000   6 x Nutrizym 22   15 x Creon 10,000   18 x Pancrex 8,000   48 x Pancrex 2,950   30 scoops Creon Micro   3 x 2.5ml spoon  

It may be most practical to combine medications. For instance, if the prescription is Creon® 25,000 x 3 with meals and 2 with snacks. These are all equal doses, using the different products: 

Creon® 25,000 x 3 with meals + Creon® 10,000 x 5, with snacks. 


Creon® 10,000 x 8 with meals + Creon® 10,000 x 5, with snacks. 


Creon® 10,000 x 8 with meals, + Pancrex® 340mg x 6, with snacks. 


Nutrizym® 22 x 3 with meals, + Pancrex® 340mg x 6, with snacks. 


Pancrex® 340mg x 10 with a meal, + Pancrex® 125mg x 16, with a snack. 


The first steps if supplies are limited, meaning you have some PERT but less than your usual amount: 

  • Ask your doctor about taking a proton pump inhibitor (omeprazole® / pantoprazole®/ lansoprazole®) or an (H2)-receptor antagonist (Famotidine® / Nizatidine®). These reduce the acid in your stomach and make the PERT work better. This means a lower dose of PERT may work if you have a proton pump inhibitor. If this does not appear to be effective, they may be stopped. 
  • Reduce the dose of PERT you take with snacks before reducing your doses with meals. This is because meals tend to be more nutritious.
  • Take one less PERT capsule with each meal and snack. Don’t skip whole meal doses. 
  • If you have some high-dose PERT (eg Creon 25,000/ Nutrizym 22), take it with you when you go out. Use the low-dose ones at home. This will cut the number of capsules you need to take out. 
  • Prioritise taking PERT with the meals that have the most protein and energy in them. 

If you do not take vitamins and minerals, it is recommended that you take a calcium and vitamin D supplement. Check the label. It should have 800 iu Vitamin D and at least 500mg Calcium. Also, take a multi-vitamin and mineral supplement during this time. For example: 

  • Sanatogen A-Z Complete® 
  • Centrum Advance® 
  • Supermarket own A-Z brand.  

Please make sure these contain both vitamins and minerals.  

People with CF should keep taking their vitamins and minerals. They should discuss any concerns with their CF specialist dietitian. 

Please contact your dietitian, nurse, or doctor if you struggle with malabsorption or keep losing weight. 

This is seen behind the back of a man's head while he is holding his phone with both hands and staring at the screen reading the information present.

If you have diabetes: 

Check your blood glucose levels regularly. They should be checked: 

  • Before meals 
  • Before bed 
  • If you are feeling unwell 
  • If you feel like you are having a hypo*  
  • If you are more active than usual 
  • Before driving and every 1-2 hours if driving long distances.  

If you take less enzymes with your food, you are likely to absorb less carbohydrate from it. Therefore, you may need to reduce the amount of quick-acting or mixed insulin you inject to prevent a hypo*. 

*A hypo is when your blood glucose level goes below 4mmol/l, typical symptoms include sweating, shaking, blurred vision, confusion, palpitations. Always keep hypo treatment on you. 

You can find more information on recognising and treating a hypo from your diabetes team or here. If you would like a printed copy of this information e-mail: info@gutscharity.org.uk or call us: 020 7486 0341. You are only at risk of a hypo if you take medication that lower your blood glucose levels. It is not usually possible to have a hypo if you are not taking insulin or gliclazide. 

If you have a continuous glucose monitor, ensure you have the hypoglycaemic alarm set. If you are having more hypos than usual, you may need to contact your diabetes team for advice on adjusting your insulin doses. 


This section is for people who do not have enough PERT and develop symptoms, such as diarrhoea, severe bloating, or a sudden need to have a bowel movement. Check the list of symptoms on this page, above. Here are some other steps to try in addition to those above: 

  • If you have diarrhoea, take loperamide / Imodium® before you eat a meal. This should help to slow down your gut and reduce diarrhoea. The longer food is within your gut, the more chance more of it will be absorbed by your body.  
  • Reduce the amount of fat in your meal to ½ of your normal portion size of higher-fat foods. See Table 3 for information on higher-fat foods. This will likely improve some of your gut symptoms. But, it won’t help you take in more nutrients. It also won’t prevent malnutrition. So, keep a close eye on your weight and strength. 
  • If you eat a lot of high-fibre foods, consider eating less of them. Very high-fibre foods can bind to enzymes in PERT and make them less effective (see Table 4 for information on higher-fibre foods). Healthy eating guidelines recommend adults try to eat 30g of fibre per day. We recommend with less PERT you do not exceed 40g per day. 

  • If you do not have diabetes, use sugary foods and drinks to increase your energy intake. Table sugar is absorbed in your gut without enzymes. So, the following can keep your energy up: 
  • Caffeine-free energy drinks such as Lucozade.  
  • Adding sugar/honey/syrup to food. 
  • Nibbling on sugary sweets/marshmallows (not chocolate).  
  • These suggestions do not provide any other nutrition. So, make sure you get protein, vitamins, and minerals from other sources. 


If any one or more of these circumstances occur: 

  • You are unable to get hold of any PERT at all. 
  • You do not have enough PERT and are losing weight. If you are losing more than 2kg (4lb) a month. Or you are already underweight and losing more than 1kg (2lb) a month. 
  • You don’t have enough PERT. Plus, you have bowel symptoms that are unmanageable and restrict your social, work, and education activities. 

A digital character drawing of a white woman wearing a green jumper and navy trousers. The image is cropped to show the top of the trousers and upwards, and she is holding her hands to her stomach in pain. She has a pained look on her face.

If you are under the care of a hospital team, contact them. See if they have enough supplies to issue a prescription for you. You will have to travel to the hospital to collect these if they have some available. 

Tell your pharmacist that you have completely run out. This is so your supplies can be prioritised if possible. 

Try not to worry. Supplies are regularly coming into the country, so this should be a short-term issue. 

Contact your GP. Ask for a prescription for a peptide nutritional drink. (Vital 1.5kcal® or Peptisip Energy HP®). Show them this leaflet. Or show them the position statement. Both could help. If you are known to a dietitian, they can be contacted too. But, because of the huge increase in workload from this PERT shortage, you are likely to get them more quickly if you go directly to your GP. These drinks can be used instead of meals until you have your PERT again. If you do not have diabetes, you can keep having sugary foods and drinks. Table 2 shows how many supplement drinks you should take if you do not have any PERT at all. 

Table 2 shows the recommended doses for peptide-based nutritional supplement drinks if you are unable to eat any food due to your malabsorption symptoms. 

Body weight   Supplements needed per day  

(Vital 1.5kcal® or Peptisip Energy HP®)  

Below 40kg (6st 4lb)   Contact a dietitian  
40 – 50kg (6st 4lb- 7st 12lb)   4 x 200ml bottles = 1200kcal  
50 – 60kg (7st 12lb – 9st 6lb)   5 x 200ml bottles = 1500kcal  
60 – 70kg (9st 6lb – 11st)   6 x 200ml bottles = 1800kcal  
70 – 80kg (11st – 12st 8lb)   7 x 200ml bottles = 2100kcal  
80 – 90kg (12st 8lb – 14st 2lb)   8 x 200ml bottles = 2400kcal  
Over 90kg (14st 2lb)   Contact a dietitian  

This may underestimate your needs. If you lose weight or are very active, add one more bottle per day. If you gain weight and were not intending to – reduce by 1 bottle per day. 

They do not come in many flavours. But you can add milkshake mixes or coffee syrups to expand the flavours. Serve them chilled. Or freeze them into ice lolly moulds or ice cube trays for more variety. 

Table 3 shows high fat foods and their lower fat alternatives. 

  Reduce your portion sizes of these:  Have these instead: 
Fats and oils   Butter, lard, Ghee, Margarine, cooking oils   Small portions of low-fat spreads  

Use spray on cooking oils if needed  

Dairy products   Full fat milk / yoghurt  


Crème Fraiche  


Semi-skimmed or skimmed milk.  

Low fat yoghurts  

Use small amounts of grated cheese instead of slices of cheese – choose stronger cheeses to maximise taste.  

To increase your protein intake, make skimmed milk powder up using skimmed milk. Use it in place of milk throughout the day  

Meat and Fish   Fried foods or foods cooked in batter.  

Skins / visible fat on meat  

Tinned fish, tinned in oil  

Meat and fish cooked without added oil.  

Tinned fish, tinned in spring water / brine  

Plant based protein sources   Nut butters   Pulses (e.g. lentils, chickpeas, beans (note portion sizes in table 2)  

Quorn / Tofu – up to 100g  

Fruit & vegetables   No restrictions for low fat, see Table 4 for fibre suggestions  
Carbohydrate based foods   Croissants, pastries  

Chips / Fried  

Roast potatoes  

Bread, Breakfast cereals  

Potatoes, rice, pasta, cooked without added fat  

Sauces / Condiments   Cheese based sauces  

Creamy sauces (bearnaise, hollandaise etc.,)  

Large portions of mayonnaise  

Tomato based sauces, gravy, mustard, tomato ketchup, soy sauce, mint jelly, vinegar, or low-fat salad dressings  

 Table 4 shows the fibre content of high fibre foods. Aim for less than 40g fibre per day. 

Very high fibre foods   High fibre foods 
Food   Portion providing 10g fibre   Food   Portion providing 5g fibre   Food   Portion providing 5g fibre  
All bran®   40g   Whole wheat pitta   1 large   Weetabix®   2 biscuits  
Brown pasta   250g (cooked)   Rye based crackers (i.e. Ryvita®)   4 biscuits   Shredded wheat®   2 biscuits  
Baked Beans   300g   Branflakes®/ Sultana Bran®, Fruit n/Fibre®   30g bowl   Porridge / Readybrek®   Large bowl (60g oats)  
Dried apricots / prunes   120g   Jacket potato with skin   1 medium   Pasta (white)   250g (cooked)  
Nuts and seeds   150g   Wholemeal spaghetti   150g (cooked)   Wholemeal bread   100g  
Dried lentils / chickpeas /Mung beans   100g (weight before cooking)   Baked beans   150g   Quorn®   75g  
Dried soya beans / red kidney beans   70g (weight before cooking)   Green beans / peas (fresh or frozen)   120g   Spinach   5 tablespoons  
Desiccated coconut   70g   Sweetcorn   7 tablespoons   Avocado pear   1 whole fruit  


For people who already have a gastric feeding tube 

If you have a PEG, RIG or NG (nasogastric) feeding tube, you could take your PERT using a powdered source. For example, Pancrex® V powder. You would take it through the tube. These can be dissolved in water and flushed down the tube, but this must be done at the time you eat. This does not work with a jejunostomy or naso-jejunal tube. The enzymes will not mix with your food. If you have a feeding tube, discuss this choice with your dietitian


Here at Guts UK charity, we support people with pancreatitis and pancreatic exocrine insufficiency. This includes pancreatic exocrine insufficiency caused by stomach surgery and diabetes. 

Contact by phone: 020 7486 0341 (9am-5pm Monday – Friday) 

Contact by e-mail: info@gutscharity.org.uk

Pancreatic Cancer UK

Contact by phone – Support Line: 0808 801 0707 (9am – 4pm Monday, Tuesday, Thursday and Friday and 10am-4pm Wednesday)

Contact by e-mail: nurse@pancreaticcancer.org.uk

Cystic Fibrosis Trust 

Contact by phone: 0300 373 1000 or 020 3795 2184 (10am – 4pm Monday – Friday)

Contact by e-mail: helpline@cysticfibrosis.org.uk

Chat on Facebook, Twitter or Instagram.

Message via WhatsApp: 07361 582053

Neuroendocrine Cancer UK

Contact by phone – helpline: 0800 434 6476 (10am – 4pm Tuesday – Thursday)

Contact by form: on the website

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