Instructions
Enzyme preparations obtained from pig pancreatic juice extract have been used in the treatment of digestive diseases for a long time. But not all of them are considered effective, since most drugs are destroyed under the influence of gastric juice. But there are modern drugs - Ermital or Creon.
The role of pancreatic enzymes
Enzymes are important elements that are components of pancreatic juice. Each of them performs its own function. There are 3 main enzymes in the form of lipase, amylase, protease. They are located in the mouth, stomach and small intestine. Such substances, when ingested by food, contribute to the successful breakdown of proteins, fats and carbohydrates.
Lipase is considered the most important enzyme. This is explained by the fact that this substance is produced only by the pancreas. Protease and amylase are found in saliva and gastric juice. Lipase breaks down lipids, amylase breaks down carbohydrates, protease breaks down proteins. In medicine, there are standards that determine the presence of substances in an adult body.
When enzyme levels decrease, health problems occur. To restore the functioning of the digestive tract, doctors prescribe enzyme preparations.
Comparison of safety of Creon 1000i and Ermitali
The safety of a drug includes many factors.
At the same time, Creon has 1000 and is quite similar to Hermital. It is important where the drug is metabolized: drugs are excreted from the body either unchanged or in the form of products of their biochemical transformations. Metabolism occurs spontaneously, but most often involves major organs such as the liver, kidneys, lungs, skin, brain and others. When assessing the metabolism of Creon 1000i, as well as Ermital, we look at which organ is the metabolizing organ and how critical the effect on it is.
The risk-benefit ratio is when the prescription of a drug is undesirable, but justified under certain conditions and circumstances, with the obligatory observance of caution in use. At the same time, Creon 1000i does not have any risks when used, just like Ermital.
Also, when calculating safety, it is taken into account whether only allergic reactions occur or possible dysfunction of the main organs. In other matters, as well as the reversibility of the consequences of using Creon 1000i and Ermital.
How do Hermital and Creon act on the body?
The effect of medications is aimed at replenishing the missing pancreatic enzymes. The main active ingredient is pancreatin. Therefore, the drugs are characterized by lipolytic, amyolytic and proteolytic properties. Enzymes lead to a thorough breakdown of proteins, fats and carbohydrates.
Medicines normalize digestion and improve the general condition of the gastrointestinal system. The release of enzymes occurs only in the lumen of the small intestine under the influence of an alkaline environment.
Medicines reduce the load on the organ, ensuring complete digestion of food. Pathological flatulence is eliminated. The effect after use is observed 30 minutes after consuming the capsules.
Creon
Creon is available in enteric granules and capsules. There are Creon Micro, Creon 10 thousand, 25 thousand, 40 thousand units on sale. pancreatin as an active component . It is used to improve digestion. Pancreatic enzymes, which are part of the medication, facilitate the breakdown of proteins, lipids and carbohydrates, and they are completely absorbed in the small intestine.
To manufacture the drug, a special technology is used, which allows the active substance to be thoroughly mixed with intestinal contents, as a result of which the enzymes are better distributed in the intestines.
When the drug reaches the small intestine, where the pH is greater than 5.5, its enteric coating is rapidly destroyed and enzymes with lipolytic, amylolytic and proteolytic effects are released, which leads to the breakdown of lipids, proteins and carbohydrates.
The compounds obtained as a result of splitting are either absorbed directly or subjected to further hydrolysis by intestinal enzymes.
According to the chemical structure, the active substance is proteins; once they enter the gastrointestinal tract, they disintegrate during the process of proteolysis and are then absorbed in the form of peptides and amino acids.
Which is better Hermital or Creon?
What is best to choose depends on the indications and age of the patient. First of all, the emphasis is on the composition. Creon includes only pancreatin in dosages of 10,000, 25,000 and 40,000 units.
Ermital contains 10,000, 25,000 or 36,000 units of pancreatin, depending on the form of release. Methacrylic acid copolymers are also added. They help protect tablets from the adverse effects of hydrochloric acid.
One of the main advantages of using medications is the complete preservation of the dose of the active substance when passing through the gastric cavity.
Pancreatin, when processed, turns into mini-microspheres and mini-tablets. They dissolve only in an alkaline environment. The particle size of Creon is 1.2 mm, Hermital is 1.8 mm. This makes them easier to mix with food.
The advantage of Hermital is its low cost. But after research, it turned out that patients are more likely to experience side effects when taking the drug.
Reviews from doctors
According to medical communities, when choosing drugs with enzymes, preference should be given to 4th generation drugs. They have high bioavailability and effectiveness, quickly reduce steatorrhea, and better relieve pain and symptoms of dyspepsia.
Olga K., therapist, Sochi
The medications fully restore digestive function in a short period of time, reduce the severity of symptoms of damage to the gastrointestinal tract, and combine well in combination therapy with other medications. I did not observe any side effects.
Lev R., gastroenterologist, Lipetsk
The appearance of enzyme preparations in minimicrospheres and minitablets has increased the effectiveness of replacement therapy.
These medications are not prescribed for acute pancreatitis and exacerbation of the chronic form of the disease.
Indications for use
Enzyme agents are recommended for use as an additional treatment for:
- cystic fibrosis,
- chronic pancreatitis,
- pancreatic cancer,
- obstruction of the gastrointestinal tract,
- Shwachman-Diamond syndrome.
Enzymes are included in conservative therapy for the following conditions and pathologies:
- partial resection of the gastric cavity,
- total gastrectomy,
- biliary obstruction,
- liver cirrhosis,
- cholestatic hepatitis,
- development of pathologies in the terminal section.
It is recommended to take medications for a sedentary lifestyle, impaired chewing function, prolonged immobilization, and frequent overeating.
Enzymes are used before ultrasound diagnostics or x-ray examination of the digestive tract.
Prescribed to elderly patients with exocrine insufficiency.
Hermital
As a therapeutic component, the drug contains standard highly active pancreatin . It is made from pig pancreas. It is produced in capsules, which contain microtablets that are resistant to the effects of stomach hydrochloric acid.
The medication compensates for the lack of pancreatic enzymes.
The enzymes included in pancreatin: α-amylase, lipase, chymotrypsin and trypsin, break down proteins into amino acids, starch into fast carbohydrates and dextrins, lipids into glycerol and fatty acids. They normalize digestion and improve the function of the digestive tract.
Microtablets are released from the capsule under the action of gastric juice, which are mixed with chyme and then enter the intestine, where their shell is destroyed; in the duodenum, the active substance is quickly released.
Pancreatic enzymes are not adsorbed into the blood; they are inactivated and digested in the intestine as a result of self-digestion and proteolysis, since they are proteins.
Method of using Hermital and Creon
Capsules are intended for internal use. Take with plenty of liquid or fruit juice. The dosage is selected individually depending on the indications and age of the patient. Adults are prescribed 150,000 units per day. Frequency of application: three times a day.
In childhood, the amount of the drug taken is calculated based on body weight. There are 20,000 units of enzymes per 1 kg of weight. When overeating, medications are taken once during a meal.
Similarities of means
Ermital and Creon are prescribed for a lack of pancreatic enzymes, which is observed in the following pathologies:
- Cystic fibrosis.
- Chronic inflammation of the pancreas.
- Condition after partial or complete resection of the stomach.
- Malignant tumor of the pancreas.
- Blockage of the bile ducts.
- Condition after surgery on the pancreas or an attack of acute pancreatitis.
- Shwachman-Damond syndrome.
If the patient cannot swallow the drug capsules, they can be opened and the contents mixed with liquid food; the resulting mixture must be taken immediately; it is prohibited to store it.
In addition, the drugs have the following similarities:
- The drugs can be taken during pregnancy and lactation; they are approved for children.
- Medicines should not be taken if you are hypersensitive to their constituent components.
- Treatment with enzymatic agents does not affect the ability to drive vehicles.
- Taking medications may cause abdominal pain, nausea, vomiting, stool retention, bloating, upset stomach, intestinal strictures, rashes, itching, urticaria, and anaphylactic reactions. Microgranules and microtablets should be swallowed whole as they contain active enzymes which, if released in the mouth, can cause irritation and ulceration of the mucous membrane.
- When taking enzyme preparations in dosages higher than therapeutic ones, hyperuricemia and hyperuricosuria may occur. When they appear, medications are discontinued and symptomatic therapy is prescribed.
- Medicines do not lose their therapeutic properties at an air temperature of no higher than 25 degrees .
- If enzyme agents are taken in a daily dosage of more than 10 thousand lipase units per kg of weight, you need to carefully monitor your well-being, note all unusual signs and unwanted reactions from the digestive organs, and if necessary, undergo a medical examination to exclude fibrosing colonopathy.
special instructions
For long-term treatment, it is recommended to take iron-based medications.
When taking enzymes in large doses during treatment for cystic fibrosis, the development of colitis, stricture of the cecum or ileum is possible.
Pregnancy and lactation
Medicines can be taken during pregnancy and breastfeeding. No dose adjustment is required.
Childhood
Creon is prescribed to children over 1 year of age. The medication is given to infants for persistent colic, constipation or diarrhea with particles of undigested food, and bloating. Ermital is prescribed for cystic fibrosis in children under 4 years of age. The dosage is calculated based on the child’s body weight. For other pathologies, the medication is indicated for children from 4 years of age.
Elderly age
The drugs are used to treat elderly patients with exocrine pancreatic insufficiency.
How effective are enzyme products?
Over the many years of clinical use of Creon, more than 20 placebo-controlled randomized studies have been conducted. A retrospective analysis showed that in various forms of exocrine pancreatic insufficiency (chronic pancreatitis, gland resection, cystic fibrosis), the use of Creon reduced steatorrhea in patients by 25–30% compared with the placebo group.
The rate of protein absorption in patients taking the drug for several months was 97%, while in the placebo group it was only 24%.
At the same time, side effects in the form of gastrointestinal symptoms were observed in the group taking Creon no more often than in the placebo group. Interestingly, when patients were prescribed drugs to reduce acidity (proton pump inhibitors, histamine H2 receptor blockers) in combination with enzymes, the incidence of complications increased.
Cost of courses for adults and children
If we compare Creon and Ermital, the price of drugs with the same activity differs by almost 2 times. The price of Creon 25,000 (20 capsules) ranges from 600 to 650 rubles. Ermital of the same activity and in the same quantity costs from 340 to 380 rubles.
If the recommended intake for an adult is 2 capsules per meal, then at least 6 capsules will be required per day. A package of 20 capsules will not last long. It is more profitable to buy a pack of Ermital (25,000 units), which contains 50 capsules. Its price is approximately equal to a package of Creon 25000, which contains only 20 pieces.
Enzyme agents with an activity of 10,000 units are usually used in pediatric practice. For children 3-4 years old (weighing up to 20 kg), half a capsule is required, and for 3 doses – 1.5 capsules. Then a package of medicine for 20 capsules will last for almost 2 weeks. The price of such a package of Ermital is about 200 rubles, Creon costs 40% more.
Differences
Hermital and Creon have the following differences:
- In addition to the indications for use listed above, Ermital is prescribed to improve digestion processes in people with normal function of the gastrointestinal tract in case of dietary disorders. It can be used as a symptomatic treatment of digestive disorders caused by cholestatic hepatitis, intestinal dysbiosis, cirrhosis, Crohn's disease.
- Creon 40 thousand units is a prescription drug . In other dosages it is sold without a prescription, like Ermital capsules.
- Creon 10 thousand units has a shelf life of 24 months . In other dosages, it does not lose its enzymatic activity for 36 months from the date of release. But it must be borne in mind that Creon, regardless of the release form and dose, can be used within 3 months after opening the package. Ermital capsules have a shelf life of 36 months.
- Drug interactions between Creon and other drugs have not been described. While taking the medication Ermital, the absorption of folic acid may decrease, as well as the effect of oral hypoglycemic drugs based on acarbose and miglitol.
Medicines are interchangeable and the differences between them are insignificant, but you can replace one medicine with another after consultation with your doctor.
Medicine and healthComment
Main characteristics of Hermital
The drug "Ermital" is used in cases where it is necessary to replenish the missing pancreatic enzymes in the human body. Available in the form of capsules with different pancreatin contents, which shows the level of activity of the active substance.
The following types of Hermital are distinguished:
- Ermital 10,000 units.
- Ermital 25,000 units.
- Ermital 36,000 units.
The variety of enzymatic activity of the drug allows you to make the most optimal choice when developing the main therapy.
The active substances are absorbed into the intestinal walls, providing the necessary pharmacological effects without entering the bloodstream.
Indications for use of the drug:
- Prevention of the digestive process, elimination of the consequences of poor nutrition.
- Inflammation and insufficiency of the pancreas.
- Pancreas cancer.
- Cystic fibrosis.
- Chronic pancreatitis.
- Digestive failure due to gastric resection.
- Dysbacteriosis.
- Cirrhosis of the liver.
- Obstruction of the biliary tract.
The advisability of using the medicine and its dosage is determined only by the attending physician. Self-medication can be dangerous to health; incorrect dosage of enzymes will worsen the condition of the gastrointestinal tract.
As mentioned above, the doctor must select the correct dosage in order to restore the balance of pancreatic enzymes as effectively as possible. Most often, the amount of the drug is determined by the patient’s age, weight, and the main indication for use.
Ermital capsules are swallowed whole during a meal, washed down with plenty of water. Violation of the integrity of the shell, its fragmentation, will lead to the loss of the main effect of the drug, since its more active substances will lose protection from gastric juice. During therapy with Hermital, it is recommended to drink large amounts of fluid.
In medical practice, possible side effects from the use of an enzyme preparation have been identified. Most of them are associated with the underlying human disease. Abdominal pain, diarrhea, nausea, vomiting and bloating may occur. In rare cases, the patient develops a rash and itchy skin.
With all these comments, Ermital has proven its effectiveness and, with a competent course of treatment, will not cause harm to health or cause discomfort.
