EPI * Exocrine Pancreatic Insufficiency

International EPI Products

The following are recommendations and personal experiences of EPI FORUM members with commonly used products for dogs with EPI from around the world.

If preparing your own home-prepared food.... trying to avoid grains can be challenging. Some of the alternative options to grains (rice, wheat, barley, oatmeal etc) we have found that is tolerable for EPI dogs are the following (used to bulk up meals):

1. Sweet potato
2. Potato (although sweet potato is better than white)
3. Tapioca pearls (cooked with water only)

Comparing different measurements: http://www.ladyoftheearth.com/homespun/weights-measures.txt

AUSTRALIA

Antibiotics in Australia: 

Are Tylan and Flagyl

Enzymes in Australia:

We don't have much of a choice over here as far as Enzymes are concerned.  We use an enteric coated capsule called Creon.  It comes in three strengths.  Most of us use Creon 10000 and I also have the 5000 strength for times when my EPI dog has had more food or a small snack.  All the Aussies I know use Creon, and luckily they work well.  They are a 'for humans' capsule & we buy them at our local pharmacy.  My vet has always stated that they need to be swallowed whole because they won’t work if the dog chews the tinymicrospheres.  We have always done that, but I do know some over here who open the capsules & sprinkle on the food.  This is o.k., even though my vet personally does not agree with this , as long as the dog eats the food immediately.  The contents of the capsule must not 'sit' on the food.  We also use an enzyme supplement called Enzyplex which is a powder that we put on the food & that sits for 15 or so minutes.   It is only asupplement though, & will not work on it's own. 

Grain-FreeFood in Australia

Artemis     http://www.pookinuk.com.au/product-selected.asp?productID=541

EVO grain free foods

Many in Australiado home cooked/prepared

This is mainly applicable to people inAustralia but the supplier that I have been using to get kibble fromfor my 2 dogs, now have the Canidae Grain Free product. Accordingto the website they have 2 flavours - Salmon &Chicken/Turkey/Lamb/Fish.  Click on the following for more info and prices..

  http://www.pookinuk.com.au/product-selected.asp?productID=960

  http://www.pookinuk.com.au/product-selected.asp?productID=959

EUROPE

Enzymes

(per FORUM member Susan) I just wanted to mention the product we got inGermany It has worked better than anything else we tried in Canada. you may want try PETZYM  it was 105 euro for 650Gram and we give 1 1/2 tsp with each meal. Letting it sit after mixingwell with warm water does seem to help. When we first got the news ifEPI we were in Germany and Zorro was really sick. With the first mealhe seemed to just sigh with relief! As far as food we started withHills Prescription Diet ID Canned making a slurry with warm water andthe PETZYM (I/D even lists EPI in it's reason to feed). It is made by Aristavet ® PETZYM 85g You will have to use the translator link ...automatically offered when you click on it's link  http://www.tradoria.de/p/aristavet-petzym-85g-37561747

UNITED KINGDOM

Antibiotics in UK:

Many times Synulox and Metronidazole are used together when SIBO ispresent. At a shorter duration than the 28 days that Metro or Tylosin are prescribed in the US.

Stomogyl antibiotics for 14 day course

I used Metroinidazole for 14 days with Synulox for 28 days for heavy e.coli infection/SIBO

Overall veterinary community is more restrained than the United States in regards to antibiotic prescriptions

Per Debra from the UK:

Stomorgyl- Pink circularfilm-coated tablets. Each tablet contains spiramycin and metronidazole. Three strengths are available: (used for intestinal bacteria)

Treating - Metronidazole has antimicrobial activity against most anaerobes,including Bacteroides,Fusobacterium and spirochaetes. Spiramycin has atherapeutic spectrum including Gram-positive aerobes such as staphylococci,streptococci and Bacillus, but also including anaerobes such as Actinomyces,Clostridiumand Bacteroides.  

STOMORGYL 2: Each tablet contains 46.9 mg spiramycin of standardpotency (3,200 IU/mg), and 25 mg metronidazole.

STOMORGYL 10: Each tablet contains 234.4 mg spiramycin of standardpotency (3,200 IU/mg), and 125 mg metronidazole.

STOMORGYL 20: Each tablet contains 469 mg spiramycin of standardpotency (3,200 IU/mg), and 250 mg metronidazole

Synulox- Palatable Tablets are presented ascircular, pink tablets with a break line on one face and `SYNULOX' engraved on the other. Each tabletc ontains clavulanic acid as potassium clavulanate and amoxicillin as Amoxicillin trihydrate in a palatable base. (a broad spectrumantibiotic)

Treating  - Staphylococci (including β-lactamaseproducing strains);Clostridia; Corynebacteria; Peptostreptococcusspp;Streptococci.Gram-negative:Bacteroides spp (including β-lactamaseproducingstrains); Escherichia coli (including most β-lactamaseproducing strains);Salmonellae (including β-lactamase producingstrains); Bordetellabronchiseptica; Campylobacter spp; Fusobacteriumnecrophorum; Klebsiellae;Pasteurellae; Proteu

Marbocyl (containing marbofloxacin).Marbocylis indicated in the treatment of skin and soft tissue infections (skinfold pyoderma, impetigo, folliculitis, furunculosis,cellulitis),for the treatment of urinary tract infections associated or not with prostatitis and respiratory tract infections, caused by susceptible strains of organisms.

(Bonnie didn’t do well on Marbocyl..Herdiarrhoea got worse soon after her first dose but vet said to continue for atleast four days but I lasted two and we changed to Synulox and she improved…

Enzymes in UK:  

http://www.nutrecare.co.uk/prod2.asp?ID=115&sub_cat=491

In the UK ,Lypex is commonly recommended. It is an enzymatic concentrate derived from theporcine pancreas gland, available in capsules, must be opened and sprinkled on food. Do not incubate on the food. The purified and concentrated pancreatic enzymes are made into micro-pellets and each pallet is enteric-coated. This gives 100% protection to the enzymes from the damaging degradative acids present in the stomach.

Lypex is an enteric coated enzyme capsule that isopened and sprinkled on food, mixed in gently and fed immediately. Rate of use is (for example with one EPI dog) 3/4 capsule on 7oz Bakers kibble soaked until soft. 1/2 capsule sprinkled on 12oz raw.

Within ten minutes of the pellets passing the stomach to the alkaline environment of the small intestine the protective enteric coating dissolves and releases the protected enzymes to maximize digestion.(available in England and Europe).

(per Debra) Lypex is stronger 1 x per 100gm -  sprinkled on food and eaten immediately - NO INCUBATION required.

(per Debra) Tryplase as an alternative is ok (I've usedthat) cheaper...but it is a bit of false economy as depending on the dog, you can have up to 5/6 capsules per meal...capsules opened and sprinkled on food and incubated

Tryplase  is another pancreatic enzyme replacement that are capsules sprinkled on food. Tryplase needs to be pre-digested for about 30/40 mins because like most enzymes it is caustic at first and will cool as it works the food. Some can serve at once but most let it pre-digest to avoid thedog having a sore mouth..

Tryplase are capsules and must be opened and sprinkled on food... Rate for my EPI dog  is 1Tryplase capsule sprinkled on 12oz raw... pre-digest 40 mins for best results. I use 1 1/2 capsules on 7oz Bakers soaked until soft...pre-digest 40 minutes for best results

My vets (Debra) uses Tryplase capsules or Pancrex EnzymePowder……Lypex is not so widely known (first produced for humans then adjusted for animals) its probably more expensive, but then you use one capsule to 4/5/6 tryplase.

Panzyme

Lipase 38,000 BP units/g

Amylase 32,500 BP units/g

Protease 2,100 BP units/g

Tryplace

 Amylase not less than 9000 B.P. Units

Lipase not less than 13,000 B.P. Units

Protease not less than 450 B.P. Units

(From Val) It looks like the Panzyme above is stronger than my Tryplase.

Could be you need to use less per meal... how much are you feeding?

And is the food home cooked or kibble?

Pancrex granules 300g

[MEPAN01]£44.31inc VAT http://www.myonlinevet.co.uk/Pancrex-granules-300g.html

 Pancrex granules contain the same enzymes that the normal pancreas glandprovides to help digest food and which are absent or deficient inanimals with so-called ‘exocrine pancreatic enzyme insufficiency’.Formulated and originally intended for human use butfinding a useful role in helping care for animals too. Pancrex granules contain the pancreatic enzymes lipase, amylase and protease. These assist  the digestion of fat, carbohydrates and proteins. The enzymes in Pancrex granules are extracted from pig pancreas glands. The use of this product should only follow a veterinary diagnosis that it is needed by your pet. The granules are ‘enteric coated’ which means they must be given whole and swallowed unchewed to allow the intact coating to let them pass unharmed through the stomach’s acid environment and into the intestine where they have their effect.

Give at a dose rate recommended by your own vet.

Container of 300g.

If anyone is interested in obtaining RAW PIG PANCREAS in the UK to treat their EPI dog with... please contact Lesley Osborne at

http://rawtogo.co.uk/default.aspx

Raw To Go

The WarehouseMarket Street

Abergavenny

MonmouthshireNP7 5SD

Telephone: 01873 268086

GrainFreefood in UK (and/or grain foods that some in the UK use)

Orijen    http://www.orijenpetfoods.co.uk/

Nutrix "Hypoallergenic Duck and Potato Formulated without any Grains or Cereals" EXCELLENT for EPI dogs

(members here on the FORUM have found great success using this food for their EPI dogs!) http://www.nutrixpetfoods.co.uk/  

BakersComplete with Chicken and Country Vegetable  (not completely grain-free but low grain)   http://www.bakerscomplete.co.uk/

Hills (hydrolyzed food- grain are processed & broken down to be absorbed by dogs with compromising conditions)

Arden Grange fish and potato (some have used for "sensitivities") www.vetuk.co.ukits

"wet" Chappie (the "dry" Chappie dog food is loaded with grain....)

James Wellbeloved foods

BurnsPork & Potato

BurnsChicken and Rice

Simpson's Premium Natural Hypoallergenic food has been highly recommended by EPI folks in the UK
http://www.simpsonspremium.com/sensitive-dog-food

Many in the UK do home cooked/prepared meals

Some soak food in warm water to soften it

GreenTripe sources

FYI:  Green-tripe may be purchased at Dog Food Specialty stores or.... these on-line suppliers:

(UK)  http://www.butcherspetcare.com/butchers/tripe/

Dehydration

Lectade (Small Animal),  its made by Pfizer, to replace loss of electrolytes and minerals from excessive diarrhea:

Or... the home-made recipe is:

7 tbsp sugar

1 tsp salt

1 tsp baking soda

2 quarts water

UNITED STATES

Antibiotics in the US

Tylan (Tylosin) or Metronidazolefor 30 days. Tylan is preferred over Metronidazole. Sometimes vets prescribe Amoxicillin when others do not seem to work.

Enzymes in the US

Pancrezyme is an enzymatic concentrate derived from the porcine pancreas gland,available in powder form. 

Viokase an enzymatic concentrate derived from the porcine pancreas gland,available in powder or tablet form. Currently has been said to be discontinued... but still available on various websites.

CREON: (per member Merk)  "I've since switched over to creon capsules.They are also working extremely well. I prefer them over the powder because i just open the capsule and sprinkle the contents over her food. no need to let the food sit. And the price comes out to around the same per dose since it's just one capsule per meal.

CREON 10 Composition : 150 mg Pancreatin

Amylase 8,000 PhEur units (BP Units) also equals 33,400 USP units

Lipase 10,000 PhEur units (BP Units) also equals 10,000 USP units

Protease 600 Ph Eur units (BP units) also equal 37,500 USP units

CREON 25 Composition : 300 mg Pancreatin

Amylase 18,000 PhEur units (BP Units) also equals 74,700 USP units

Lipase 25,000 PhEur units (BP Units) also equals 25,000 USP units

Protease 1,000 Ph Eur units (BP units) also equal 62,500 USP units

I order mine from a Canadian site canadadrugpharmacy - 100 pills for $50or 800 pills for $260. I ordered the 100 pills about 2-3 weeks ago and just put in an order for the 800 count which is what i'll do from now on since that'll be the cheapest. Doing it this way has made it the easiest for me. Just mix in one pill in with her food and it's all good.

If you do a Froogle search (google.com/froogle) for creon, that canadian site should be one of the two that pops up at the top of the page."

(From another member Karen regarding CREON):

I am showing that the Creon is an over the counter medication so you will not need a prescription.Please make sure you do confirm with your veterinarian the proper dosage for you animal.

Your questions and comments are important to us. If you require further assistance, please contact useither online or by phoning 1-800-891-0844

Kind regards,

Customer Service

www.canadapharmacy.com

Pancreatin an enzymatic concentrate derived from the porcine pancreas gland,available in powder.

Panakare Plus tablets enzymatic concentrate derived from the porcine pancreas glandwith serum concentrations of fat soluble vitamins A, E & D.  Made by Neogen Vet. 

Generic Pancreatin 6x10 and 8x10 an enzymatic concentrate derived from the porcine pancreas gland, available in powder If you have a positively VETERINARY diagnosed dog with EPI and are interested in ordering bulk-priced supplemental pork-based enzymes, they can be directly purchased from http://www.enzymediane.com/

Epizyme Epizyme is activated whole raw pancreas; a pancreatic enzyme concentrate of porcine origin containing standardized amylase, protease and lipase activities.

Total-Zymes (plant based) In some cases, a dog may have pork-based allergies, or meat protein allergies so EPI owners opt for a plant-based enzyme.

Grain-free food in the US

Blue Buffalo Fish & Sweet Potato,Blue Wilderness, Longevity-Gluten free; http://www.bluebuff.com/products/dogs/index.shtml

ChampionPet Foods Orijen Adult; http://www.orijen.ca/orijen/products/

Diamond Foods Taste of the Wild High Prairie, Taste of the Wild Wetlands; http://www.tasteofthewildpetfood.com/

Dick Van Patten Natural Balance L.I.D., Potato & Duck, Sweet Potato& Fish, Sweet Potato & Venison;    http://www.naturalbalance.net/dogformulas/home.html 

Earthborn Holistic “Primative” http://www.earthbornholisticpetfood.com/

Fromm Family Foods Whitefish & Potato and Grain FreeSurf & Turf  http://www.frommfamily.com/products-fs-d.php 

Go Natural Grain Free  http://www.petcurean.com/  

Merrick Pet Care Grammy’s Pot Pie, Mediterranean Banquet, andThanksgiving Dinner; http://www.merrickpetcare.com/store/

Natura Pet Products EVO Red Meat Small Bites, EVO Reduced Fat, and EVO 95%meat canned foods; http://www.evopet.com/

Nature’s Variety Instinct Chicken Meal and Duck Meal & TurkeyMeal; http://www.naturesvariety.com/instinct_dog

Old Mother Hubbard Venison & Salmon Stew;http://www.oldmotherhubbard.com/products_cupboard.html

Solid Gold Barking at the Moon; http://www.solidgoldhealth.com/products/

Wellness Core http://www.wellnesspetfood.com/dog_wellness_grain_index.html

WellnessSuper5Mix Whitefish & Sweet Potato, Wellness Canned Venison & SweetPotato, and Cupboard Creations Chicken Pot Pie. http://www.wellnesspetfood.com/dog_wellness_grain_index.html

Other food products used by some EPIowners with success by their EPI dog:

Iams® Veterinary Formulas Intestinal Low-Residue™/ Canine Dry Formula     (http://www.iams.com/iams/en_US/jsp/IAMS_Page.jsp?pageID=PL&productID=24)

Life4K9 Chicken & Barley (http://life4k9.com/cart.php?item_id=1)

NutriSource PureVita   (http://www.nutrisourcedogfood.com/purevita/)

Dehydration

Pedialyte or home-made Pedialyte to replace loss of electrolytes and minerals from excessive diarrhea:

The home-made recipe is:

7 tbsp sugar

1 tsp salt

1 tsp baking soda

2 quarts water

Greentripe sourcs:

( USA)  http://www.greentripe.com/     http://www.greencuisine4pets.com/

Olesia ~ Just an observation under the UK list of 'Grain-Free' foods. I am not sure if Hills offer grain-free food but I know that Hills i/d dry and canned contains: ground rice, ground maize, maize gluten meal and flaxseed, including soya and other ingredients.

Warmest best wishes,

Julie & Angel

Thanks for catching that... i need to better explain ....the Hills food I am referring to is HYDROLYZED Hills canned food. Hydrolyzation is a special process for better digestion for compromised animals:

" A process for preparing a food product for animal consumption from an animal by-product, including the steps of:

applying a hydrolyzing agent heated above ambient temperatures to exposed surfaces of an animal by-product to alter the pH of an animal by-product over said exposed surfaces to initiate hydrolysis of the animal by-product;"

"Supposedly" this is much more tolerable for some dogs,. I know people who have used this product with great success and I also know other people who's dog got sicker on this food... Once again, it's the old try it and see if it works for your individual dog......

Hi Olesia,

You are spot on regarding Hills i/d.

I've used both dry and wet - Wet tin food during bad SIBO at the beginning. This is also used for dogs after surgery as its very gentle on the stomach and Bonnie was fine on it.

Dry kibble on the other hand, increased Bonnie's thirst dreadfully, Vet advised this couldn't happen, she even had blood test for diabetes....Hill's said the same. She was on it a week, in the end I changed her over as it just wasnt right to drink that amount, the only time I've switched without slow introduction...within a day...drinking went back to normal.:dry:

Hi Olesia. 

In Oz., we can also get Evo grain free dry food & canned food, although it is sometimes hard to find.

thanks Lynn!!!  I added it to the list.

I will add some products available in France :

Antibiotics : Flagyl ;

Enzymes : Eurobiol (human use), Creon (human use), Pancrex (vet use) ;

Vet hyperdigestible food : Hill's I/D (kibble and cans) and Z/D (kibble and cans), Virbac digestive (kibble), Advance GastroEnteric (kibble and cans), Royal canin Intestinal (kibble), Royal canin hypoallergenic (kibble), Purina GastroEnteric (kibble), Purina hypoallergenic (kibble), Leo Specific Digestive Support (kibble), Integra Protect (cans), Reddy Canine Intestinal (kibble) ;

Grain-free food : Orijen (kibble), Lupovet IBDerma-Hyposens (kibble).

Olesia,

Putting idle fingers and an internet connection together is a good thing.  Now, putting idle fingers with an internet connection AND a new digital camera together could be very dangerous for the un-informed.  Great job!!!!!!!!

Frank

I have just picked up this post

I have checked Bakers Complete Chicken and Country Veg and it isn't COMPLETE grain free.

It has a small amount of unspecified 'cereals.... probably better to be described as... low grain food.

Val'