Consumer medicine information

PANZYTRAT™ 25000 Capsules

Lipase; Amylase; Protease; Pancrelipase

BRAND INFORMATION

Brand name

Panzytrat 25000

Active ingredient

Lipase; Amylase; Protease; Pancrelipase

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using PANZYTRAT™ 25000 Capsules.

What is in this leaflet

This leaflet answers some of the common questions about Panzytrat 25,000. It does not contain all of the available information. It does not take the place of talking to your doctor or pharmacist.

Please read this leaflet before you start taking Panzytrat 25,000.

If you are helping someone else take Panzytrat 25,000, please read this leaflet before you give the first dose.

All medicines have risks and benefits. Your doctor has weighed the risks of you taking Panzytrat 25,000 against the benefits expected for you.

If you have any concerns about taking Panzytrat 25,000, ask your doctor or pharmacist. Your doctor and pharmacist have more information.

Keep this leaflet with your Panzytrat 25,000. You may need to read it again.

What Panzytrat 25,000 is used for

Panzytrat 25,000 are pancreatic enzyme supplements that are used by people whose bodies do not make enough enzymes to digest their food such as patients with cystic fibrosis or chronic pancreatitis; or patients who have had their pancreas removed or who have had gastrointestinal bypass surgery or suffer from ductal obstruction. The enzymes are extracted from pig pancreas.

Panzytrat 25,000 is approved for the uses listed above. However, your doctor may prescribe this medicine for another use. If you would like more information, ask your doctor.

Panzytrat 25,000 cannot be obtained without a doctor's prescription.

There is no evidence Panzytrat 25,000 is addictive.

Before you take Panzytrat 25,000

When you must not take it

Do not take Panzytrat 25,000 if your doctor has told you that you have acute pancreatitis.

Do not take Panzytrat 25,000 if you are allergic to pork, other pig products or any of the ingredients listed at the end of this leaflet.

Do not use Panzytrat 25,000 after the expiry date (EXP) printed on the pack. If you take this medicine after the expiry date has passed, it may not work as well.

Do not use Panzytrat 25,000 if the packaging is torn or shows signs of tampering, or if the capsules do not look quite right.

Before you start to take it

You must tell your doctor if you are allergic to any other medicines or any foods, dyes or preservatives.

You must tell your doctor if you are pregnant, planning to become pregnant, are breast feeding or intend to breast feed. Your doctor will discuss whether you should take these products.

If you have not told your doctor about any of the above, tell them before you use Panzytrat 25,000

Taking other medicines

Tell your doctor if you are taking any other medicines, including any that you buy without a prescription from your pharmacy, supermarket or health food shop.

You should avoid taking antacids, which are medicines that are used to treat heartburn and indigestion, when taking Panzytrat 25,000. Antacids may affect how well Panzytrat 25,000 work by breaking down the special coating used to protect the pancreatic enzymes. If it is necessary to take an antacid, then it should be taken at least one hour before you take your Panzytrat 25,000.

How to take Panzytrat 25,000

Follow all directions given to you by your doctor carefully.

These directions may differ from the information in this leaflet.

How much to take

Your doctor will tell you how many capsules to take to suit your particular needs. Do not increase the number of capsules yourself without informing your doctor.

The usual starting dose Panzytrat 25,000 in adults (including the elderly) and children is one capsule with every meal and snack. Your doctor will probably adjust the number of capsules you are taking until the medicine is effective.

If the doctor advises you to increase the dosage, you should increase the number of capsules gradually (for example, by one at a time). A very rapid increase in dosage may lead to constipation. If you are unsure how to increase the dose, ask your doctor or pharmacist to explain it to you.

The maximum recommended dose of lipase in infants and children with cystic fibrosis is 20,000 units per kilogram body weight in 24 hours. Patients who use more than 10,000 units per kilogram per day, will probably be monitored closely by their doctor.

When to take it

Take Panzytrat 25,000 with every meal or snack.

How to take it

Swallow the capsules whole with a full glass of water or, if you prefer, open the capsules and mix the granules with soft food.

If you mix the granules with food, it is important to swallow the mixture straight away, without chewing.

Neither the capsules nor the granules inside should be chewed as they have a special coating to stop them dissolving until they have gone through the stomach and into the intestines where they work.

When you are taking Panzytrat 25,000, it is important to make sure that you drink plenty of liquid every day.

If you forget to take it

Wait until your next meal or snack and take your usual number of capsules.

Do not take a double dose to make up for the dose that you missed.

If you have trouble remembering when to take your medicine, ask your pharmacist for some hints.

If you take too much (overdose)

If you, or anybody else, have taken too much Panzytrat 25,000, drink plenty of water and contact your doctor, pharmacist or the Poisons Information Centre (13 11 26), or go to the casualty department of the hospital nearest to you. Do this even if there are no signs of discomfort or poisoning.

While you are taking Panzytrat 25,000

Things you must do

Make sure you tell your doctor if you are still having problems with fatty stools or abdominal pain while you are taking Panzytrat 25,000

Drink plenty of water every day when you are taking Panzytrat 25,000

Follow your doctor's instructions carefully and do not stop taking the capsules unless told to do so by your doctor.

If you are about to start taking any new medicines, tell your doctor and pharmacist that you are taking Panzytrat 25,000

Things you must not do

Do not give Panzytrat 25,000 to anyone else, even if they have the same condition as you.

Do not use this medicine for any purpose other than for the purpose it has been recommended for you.

Do not use more than the recommended amount.

Do not stop taking your medicine until your doctor tells you to do so.

Do not let yourself run out of medicine unless told to do so by your doctor.

Things that may help your condition

Diet should be considered as part of your overall management plan. Your doctor may advise you to watch the amount of fat in your diet.

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Panzytrat 25,000

Panzytrat 25,000 helps most people whose bodies do not make enough enzymes to digest their food, but it may have unwanted side effects in a few people. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor if you notice any of the following and they worry you:

  • stomach or bowel problems, including:
    - diarrhoea
    - constipation
    - abnormal stools
    - abdominal discomfort
    - nausea
  • skin reactions

Tell your doctor immediately if you have severe or prolonged abdominal pain. Several children with cystic fibrosis who were taking high doses of pancreatic enzyme supplements have suffered from narrowing of the bowel and required an operation.

Tell your doctor if you notice any other symptom while you are taking Panzytrat 25,000.

In rare cases, people taking very high doses have had a tendency to develop high levels of uric acid in their blood and urine.

If you take too much Panzytrat 25,000 you may get irritation or inflammation in the anal region.

Do not be alarmed by this list of possible side effects You may not experience any of them.

The active ingredient in Panzytrat 25,000 is an extract of pancreatic powder of porcine origin (pigs), therefore the presence of porcine parvovirus or other porcine viruses cannot be totally excluded. However, there is no evidence of transmission of these viruses to humans or of porcine pancreatic powder extracts causing illness in humans.

After taking Panzytrat 25,000

Storage

Keep your capsules in the bottle until it is time to take them. If you take the capsules out of the bottle they may not keep well.

Keep your Panzytrat 25,000 in a dry place where the temperature stays below 25 degrees C. Please note that in warmer climates it may be necessary to store Panzytrat 25,000 in the refrigerator.

Do not store it, or any other medicine, in the bathroom or near a sink.

Do not leave it in the car or on a window sill on hot days. Heat and dampness can destroy some medicines.

Keep it where young children cannot reach it. A locked cupboard at least one-and-half meters above the ground is a good place to store medicines.

Disposal

If your doctor tells you to stop taking Panzytrat 25,000, or the capsules have passed their expiry date, ask your pharmacist what to do with any that are left over.

Product description

What it looks like

Panzytrat 25,000 capsules are red- brown/colourless capsules containing small off-white/ beige coloured mini- tablets that have a special coating. Available in bottles of 100 capsules.

Ingredients

Each microtablet in the capsules is identical with nominal enzyme activity of:
Lipase 400 BP units, Amylase 360 BP units & Protease 20 PH Eur units.

Each Panzytrat 25,000 capsule contains Pancrelipase equivalent to not less than lipase 25,000 BP units, amylase 22,500 BP units and protease 1,250 Ph. Eur. units.

Inactive ingredients include

  • lactose,
  • microcrystalline cellulose,
  • crospovidone,
  • colloidal anhydrous silica,
  • magnesium stearate,
  • methacrylic acid copolymer,
  • triethyl citrate,
  • talc,
  • simethicone,
  • gelatin,
  • erythrosine CI45430,
  • iron oxide red CI7749 1,
  • iron oxide yellow CI77492 and
  • montan wax.

Sponsor

Panzytrat 25,000 is manufactured in Germany by Nordmark GmbH for:
Technipro-Pulmomed Pty Ltd.,
Unit 10, 13 Berry Street, CLYDE.
NSW, 2142 Australia.

Postal: P.O. Box 6390
Parramatta B.C., NSW 2150.

Tele: (02) 9897 5899
Fax: (02) 9897 5799
e-mail: [email protected]

This leaflet was last updated: 26th February 2014.

Australian Registration Numbers:
Panzytrat 25,000: AUST R 55941

Published by MIMS September 2014

BRAND INFORMATION

Brand name

Panzytrat 25000

Active ingredient

Lipase; Amylase; Protease; Pancrelipase

Schedule

S4

 

1 Name of Medicine

Pancrelipase.

2 Qualitative and Quantitative Composition

Each capsule contains 500 mg of pancrelipase enteric-coated microtablets. Minimum enzyme activities in each capsule are Lipase 25,000 B.P. units, Amylase 22,500 B.P. units, and Protease 1,250 Ph. Eur. units. See Table 1.

Excipients with known effect.

Contains sugars (as lactose).
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Panzytrat capsules.

Elongated capsule with swedish orange cap and natural transparent body containing off-white to pale grey coated microtablets.

4 Clinical Particulars

4.1 Therapeutic Indications

Panzytrat 25000 is indicated for pancreatic enzyme replacement in patients aged 18 months or more suffering with conditions associated with pancreatic exocrine insufficiency such as cystic fibrosis, chronic pancreatitis, post pancreatectomy, post-gastrointestinal bypass surgery (e.g. Billroth II gastroenterostomy) and ductal obstruction.

4.2 Dose and Method of Administration

Unless otherwise prescribed by the physician, the following doses apply.

Adults and children (from 18 months of age).

Initially one capsule with every meal and snack.

Adults.

6 capsules daily with food.

Children, older than 18 months.

4 capsules daily with food.

Children, older than 18 months with cystic fibrosis.

1500-6000 BP units lipase/kg bodyweight/meal.
The dosage should be adjusted according to the severity of the disease and the composition of the food. Care should be taken in the case of cystic fibrosis patients that the dose does not exceed that required for adequate fat absorption. Some patients may require much higher doses than shown above. Where there is total pancreatic insufficiency the entire daily requirement for lipase must be substituted, generally up to 400,000 lipase units daily.
Any increases in dosage should be conducted under medical supervision and with the aim of improving symptoms (e.g. steatorrhoea, abdominal pain). The maximum recommended daily dose of lipase is 20,000 BP units per kg bodyweight. Dose increases should be added slowly with adequate hydration at all times (approx. 100 mL of fluid with each dose). Patients requiring higher dosages should be reviewed regularly.
Agents which increase gastric pH, such as H2-antagonists and proton pump inhibitors, have been reported to increase the activity of administered pancreatic lipase. This is not an approved indication for these agents. Prescribers should decide, on the basis of the published evidence, whether or not to use them in this way. The capsules can be swallowed whole, or they may be opened and the microtablets taken with fluid or soft food, but without chewing. If the microtablets are mixed with food it is important that they are taken immediately to avoid dissolution of the enteric coating.

4.3 Contraindications

Panzytrat 25000 is contraindicated during the early stages of acute pancreatitis, and acute attacks in chronic pancreatitis, and in those patients who are known to be hypersensitive to porcine protein or any other ingredient of this preparation.

4.4 Special Warnings and Precautions for Use

Fibrosis colonopathy.

Fibrosing colonopathy has been reported in cystic fibrosis patients treated with some high dose enzyme supplements. Although causation has not been established, patients who continue to use very high dosages and who have a medical history of gastrointestinal complications should be reviewed regularly (e.g. by ultrasound).

Other precautions.

In general, low dose preparations should be used in preference to high dose products. High dose preparations may be considered in patients who may benefit from higher total enzyme activity and those who are experiencing continued symptoms due to poor compliance because of the number of low dose capsules necessary per meal.
Neither the Panzytrat 25000 capsule nor the microtablets should be crushed or chewed. In the case of difficulty in swallowing the capsule, it may be carefully opened and the enteric coated microtablets taken with liquid during the intake of food or shaken onto soft food that does not require chewing, and swallowed immediately. Food having a pH of more than 5.5 can dissolve the protective enteric coating of the microtablets (see Section 4.2 Dose and Method of Administration).
The presence of porcine parvovirus cannot be totally excluded in medicines containing extracts of pancreatic powder of porcine origin. However, porcine parvovirus is not regarded as being able to be transmitted to humans nor of causing illness in humans. The presence of porcine parvovirus may indicate the presence of other porcine viruses. However, no cases of transmission of an infectious illness have been reported in association with the use of porcine pancreatic powder extracts.

Use in the elderly.

No data available.

Paediatric use.

No data available.

Effects on laboratory tests.

No data available.

4.5 Interactions with Other Medicines and Other Forms of Interactions

Antacids should not be taken concomitantly with Panzytrat 25000 as the alkaline pH may break down the enteric coating. If antacid administration is considered necessary, it is recommended that at least one hour elapse between the intakes of antacid and Panzytrat 25000.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

No data available.
Safe use in pregnancy has not been established. Therefore, Panzytrat 25000 should not be used in the first trimester of pregnancy unless, in the judgment of the physician, the expected benefits outweigh the potential hazards.
It is not known whether any of the components of Panzytrat 25000 are excreted in breast milk or have a harmful effect on the newborn. Therefore, Panzytrat 25000 should only be used by women who are breastfeeding if the expected benefits outweigh the potential risks.

4.7 Effects on Ability to Drive and Use Machines

The effects of this medicine on a person's ability to drive and use machines were not assessed as part of its registration.

4.8 Adverse Effects (Undesirable Effects)

Diarrhoea, constipation, abdominal discomfort, nausea and skin reactions have been reported infrequently. Bowel stricture formation has occasionally been reported in children with cystic fibrosis taking high lipase pancreatic enzyme supplements, and should be considered if abdominal symptoms develop (see Section 4.4 Special Warnings and Precautions for Use).

Reporting suspected adverse effects.

Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product.
Healthcare professionals are asked to report any suspected adverse reactions at www.tga.gov.au/reporting-problems and contact Technipro-PulmoMed Pty Ltd on 1800 26 22 13.

4.9 Overdose

Neither overdosage nor accidental poisoning has been reported.
For information on the management of overdose, contact the Poisons Information Centre on 131126 (Australia).

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Mechanism of action.

Administered orally, Panzytrat 25000 assists in the digestion of fats, carbohydrates and proteins. Panzytrat 25000 has been specially formulated to combine the features of rapid, homogeneous distribution with the chyme in the stomach, with resistance to inactivation by gastric acid and rapid dissolution in the alkaline pH of the duodenum. This is achieved by enteric coated microtablets which are released in the stomach following dissolution of the gelatin capsule. The microtablets are of uniform size, shaped for maximum contact surface area (2 mm diameter convex tablets of thickness 1.90-2.10 mm), and mix with the chyme while being protected from inactivation by gastric acid (pH 1). They pass into the alkaline pH of the duodenum at least as quickly as the food they are intended to digest. The enteric coating rapidly dissolves in the duodenum. The duodenal liquid then acts on the uncoated microtablets releasing enzymes at the appropriate site to support the exocrine function of the diseased and insufficient pancreas.

Clinical trials.

No data available.

5.2 Pharmacokinetic Properties

No data available.

5.3 Preclinical Safety Data

Genotoxicity.

No data available.

Carcinogenicity.

No data available.

6 Pharmaceutical Particulars

6.1 List of Excipients

In addition, each gelatin capsule of enteric-coated microtablets contains the following inactive ingredients: lactose monohydrate, microcrystalline cellulose, crospovidone, colloidal anhydrous silica, magnesium stearate, methacrylic acid copolymer, triethyl citrate, purified talc, simethicone, gelatin, erythrosine, titanium dioxide, iron oxide red, iron oxide yellow, glycol/butylene glycol montanate.

6.2 Incompatibilities

Incompatibilities were either not assessed or not identified as part of the registration of this medicine.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Store below 25°C, in a dry place. Keep the container tightly closed.

6.5 Nature and Contents of Container

Panzytrat 25000 capsules: Bottle containing 100 capsules.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of by taking to your local pharmacy.

6.7 Physicochemical Properties

No data available.

7 Medicine Schedule (Poisons Standard)

S4 - Prescription Only Medicine.

Summary Table of Changes