My father has just started taking the pancreatic enzyme Viokase, but he is uncertain of the correct dosage. The doctor has recommended one to three tablets per day. He really needs more information.

N.

The main reason that patients are given pancreatic enzyme-replacement drugs is that they have lost the ability to produce enough enzymes on their own. A common cause of this problem is chronic pancreatitis, a condition in which the pancreas becomes scarred as a result of long-term damage, most often from alcohol. The scarring damages the gland and prevents production of key enzymes vital to the digestive process. In addition, patients who develop pancreatic cancer and have an operation to remove all or part of the gland will need enzyme replacement.

Another reason for enzyme therapy is to help ease severe pain in patients with chronic pancreatitis. This pain is thought to be partially related to pressure in the duct that drains the pancreas. It is thought that the scarring involves the duct, thus blocking the flow of pancreatic juices out of the gland during meals. Enzyme replacement alleviates such pain in many patients by providing the needed enzymes to digest the meal, thereby allowing the gland to rest.

Several pancreatic enzyme-replacement preparations are available, and they vary in the amounts of active enzymes that they contain. The dosage used depends on the reason for the therapy, either for insufficient enzyme levels or for pain relief. The recommended dosage for Viokase is in the range of one to three tablets with each meal. However, in practice most gastroenterologists who treat patients with pancreatic dysfunction approve the use of up to eight tablets with each meal to get the proper effect. Many doctors start patients with a low dose of enzymes and slowly increase the dose if necessary. Keep in mind that the enzymes can also have side effects such as abdominal cramps, bloating and diarrhea.

Your father should talk with his doctor frequently and let him know how he is doing with the dosage prescribed. Appropriate changes can then be made depending on your father's response to the therapy.