EPI * Exocrine Pancreatic Insufficiency

(This CREON information was put together by one of our EPI FORUM members Frank) THANKS FRANK!

I've been doing some research on Creon with a LOT of help from Lynn Spencer.  I've also been in contact with a Solvay Pharmaceuticals  Pharmacist  out of their US Headquarters in Marietta,Georgia USA. 

Here is some background on the product  (I'll be doing a lot of cut and pastes from different locations to keep it simple): 

Creon® is produced by Solvay Pharmaceuticals is the global market leader andthe largest manufacturer of pancreatic enzymes, with many years of experience in research and development in this field. The Creon® product range is used for the treatment of pancreatic exocrine insufficiency, associated with several underlying conditions, examples of which include cystic fibrosis, chronic pancreatitis and following pancreatic surgery.  

With particular regard to cystic fibrosis patients, pancreatic enzymes are a cornerstone of their treatment. They help these patients to digest food and avoid malnutrition.

Solvay has a worldwide presence in 50 countries, over the 5 continents, withan expanded presence in Asia, the Americasand Eastern Europe.

Creon® Mini-microspheres®

Their advanced formulation and manufacturing technology has resulted in an optimal size for the enteric coated microspheres in each Creon® capsule, known as Creon® Mini-microspheres®. Consequently it combines the features of fast, homogeneous distribution in the stomach with complete protection against inactivation by gastric juices. Creon® is designed to enable a simultaneous passage through the stomach and further into the duodenum together with the food, and a rapid release of the digestive pancreatic enzymes in the duodenum. Innovative research and development continues, offering patients real hope of further improvements in their quality of life. Creon is registered in more than 80 countries and helps thousands of patients, human and pets, worldwide. 

These are  two niche areas in which Solvay is well-established, with extensive know-how: Flu vaccines and Pancreatic enzymes 

Solvay Pharmaceutical's world wide headquarters is located in Couillet, Belgium. One reason it's not widely used in the U.S. But, they are the 1st FDA Approved Pancreatic Enzyme in the U.S.  If anyone is interested this is the web site Solvay Pharmaceutical created for Creon http://www.creon-us.com/default.htm

To show how new this drug is in the U.S. here is a short time-line: 

  May 1, 2009   Creon® wins FDA Approval

 July 7, 2009   Creon® becomes commercially available in the U.S.

Sept 9, 2009   Creon® test results published in the "Journalof Cystic Fibrosis"

As per the company Pharmacist, the formulas will soon be changing to Creon6, 12, 24.

                        Lipase                           Protease                                Amylase

                          (Fat)                              (Protein)                                  (Sugar)

Creon 6         6,000  USPunits            19,000USPunits              30,000 USP units

Creon 12     12,000  USPunits            38,000USPunits              60,000 USP units

Creon 24     24,000  USPunits            76,000USP units           120,000 USP units

Here is a condensed version  of the help Lynn Spencer, in Oz, has given. She is my expert especially after using Creon® 10 for three years.  So, Lynn I hope you don't mind my quoting you here. 

"Creon capsules are not for dogs, they are human capsules so I have never worried about the Lipase, amylase, protease thing like you do with the powders.  Actually, there has never been any reason to, because Creon capsules are the only enzymes we can get here in Oz., so we have no choice; they have to work. Being for humans, the dosage goes on meals, not cups. 

We have only ever given Megg (as per vets instructions), one capsule per meal & it has worked really well. Megg is an English Setter &weighs 26kgs (57 lbs).  My friend from the group, Wendy (she lives inTasmania), has a big GSD who weighs around 37-38kgs (84 lbs)., & she has only ever given her Tess one capsule & she is fine on that dosage.I do know of someone in Sydney who gives her dog 2 capsules, one fed whole, & one opened & sprinkled & that has worked for her dog, but I would definitely not give more than 2.  Remember these capsules are for a human adult. 

My vet has always been adamant that I feed the capsule whole, which I do,but some people do open & sprinkle the contents on the meal.  If you do this, then the dog must eat the food immediately.  The contents must not 'sit' on the food & must not be incubated.

The problem we have here, is that many vets just prescribe an enzyme' supplement'  without the Creon & the poor dogs just continue to lose weight & don't improve.  Once they start on the Creon, all comes together for them." 

My concern was trying to match the Lipase, Protease and Amylase of Pancreatin 6x to Creon 20. This is a sample of trying to match one drug to the other.  Let's say we get the Creon 20.  To get the Lipase numbers to equal I would have to give Ayasha 4 tablets, But I would be giving 9,160 USP Units of Lipase OVER her present dosage.  Under the Protease I would begiving her 148,000 USP Units LESS than her present amount, so to get those tomatch I would have to give her 6 tablets. Under the Amylase I would begiving her 246,800 USP Units LESS than her present amount, so to get these to match I would have to give her 8 tablets. 

I need everyone to understand, I am not looking to change Ayasha over to Creon permanently.  The cost is not in line with Pancreatin 8X.  The cost of using Pancreatin 8x is about $0.33 per meal.  The cheapest I can get Creon 10 from a Canadian Pharmacy is $0.55 per capsule, that also includes the shipping cost.  My plan is to use the Creon 10 only while camping, and when my wife and I are not able to be home to make Ayasha's meals or if we ever needed to board her in an emergency.  I fully understand that I need to pay for convenience.  But, like I stated earlier, the Creon would be used when convenient. 

Olesia and Lanie were on the right track with info for Hannah. Hopefully everyone has a little better understanding on Creon capsules.

UPDATE FROM FRANK ON ACQUIRING CREON REASONABLY  FEBRUARY 2010

I have some update info on purchasing Creon10.  I went on the internet and found the cheapest possible price,$43.00 USD for 100 capsules.  That was from:  www.buylowdrugs.com an online Canadian pharmacy.  The problem with this company is the amount of paperwork you have to fill out.  You have to fill it out as if your pet was a human.  you literally have to fill out 8 pages.  But the good thing was they are the lowest cost I could find, so you use hem as a bargaining chip.  Most of the internet sites will price match, but some of them are pretty slick, they will tell you they will only price match from a list they provide.  Tell them you will look elsewhere.  I went to www.canadadrugs.com. They normally sell Creon 10 for $71.85 USD for 100 capsules and free shipping.  They agreed to price match but a supervisor had to approvethe match, which they did.  I set up the account over the phone.  They recorded the setup and you agree  to the liability info so they don't need your signature.  They were aware that the patient was a dog, so the health history questions were geared to a dog and not a human.  I gave them my credit card info and they gave me an order number.  After that was done, i just needed to fax the order number and the written prescription I got from my vet to them.

I wasoriginally told the Creon 10 would be coming from England, produced at the Solvey pharmaceutical.  After the faxed info was received, I got a call telling me that there was a problem.  They could not get the Creon10 from England since the medication was for a dog.  So the medication would have to come from Canada. You got it, Solvey Pharmaceutical ofCanada.  And the price would be $71.85 USD for 100 capsules.  I told her the price was already approved at $43.00U SD.  She said she would have to take this to a supervisor, which she did.  The supervisor agreed to $43.00 USD, and that includes the shipping.

$0.43 permeal is still too high for me to feed Ayasha daily.  But for theconvenience of using it while camping and for my son to feed Ayasha when we can't make it home in time to feed her, it is worth the extra $0.10 per meal.

MARCH 10, 2009  - UPDATE FROM FRANK!

Frank put together some very comprehensive information together regarding: 

Availability & Pricing on CREON

Thanks Frank for the amazing database on CREON!!!!  To view the PDF database, please visit: 

http://www.epi4dogs.com/enzymesdigestion.htm

and scroll down to the CREON section.

"iF you are interested in purchasing CREON on-line..... one of our EPI FORUM members, Frank, put together a fabulous database on CREON including the brand name, website address, the cost of the CREON, shipping costs, and breakdown of price per capsule. This PDF is a wealth of information.Please feel free to check it out. Click on: "CREON pricing-3a.pdf"

All I need to do now is go through the testing phase when the medication comes in.  And, that should be done before camping season starts in four months.

Lynn Spencer , Thank you, thank you, thank you for all the background info you sent meon Creon 10.  It convinced my vet to go along with the testing of Creon10 on Ayasha.  When I talked with him on the phone last night, he thought the worst that could happen would be loose poop.  So he agreed with the trial, especially when this was not going to be used every day

I'll let everyone know the outcome or the poop of the trial.

Frank

Thank you Frank for researching the bset possible price on CREON and then sharing it with the group... this is really helpful and we will be looking forward to hearing Ayasha's trial with it

-----------------------------------

Hi Frank,

I have been doing some of my own experiments with CREON 10000 with reference to feeding Angel treats/snacks without any fuss, after speaking to Lynn.  I have, however, tested it on Angel's Orijen Adult diet of:

• Crude Protein 42%

• Crude Fat 16%

• Crude Fibre (Max) 3%

• Carbohydrate (Max) 18%

Per 1 capsule and it works brilliantly!   Angel's stools remain perfect in every respect. However, I intend to use CREON 5000 for giving treats, as I think the CREON 10000 is too high for this purpose. IMO: These enteric coated capsules are wonderful for easy use, no bother and ideal in every respect.  I will continue with the remaining supply I have of T-Z as it serves Angel well, but due to the length of time it takes to prepare Vs my hectic lifestyle, I will eventually switch fully to the CREON.

Warmest best wishes,

Julie & Angel

Olesia, I think this is a wonderful idea to have this information in a separate file.  Frank has done some great research & hopefully this info. will help a lot of new people who are thinking of using Creon. 

Lynn & girls. 

Thank Lynn... but a lot of the thanks goes to you too... you have explained and helped countless number of folks on this FORUM on how to use CREON !

MANY thanks to Frank and Lynn for putting this together for us.  Now that I know it is more expensive than Diane's enzymes, I will not be changing to Creon.  I will, however, try to get some for emergencies, as Frank is doing.  Great idea.