Viokace Side Effects
Generic Name: pancrelipase
Note: This page contains side effects data for the generic drug pancrelipase. It is possible that some of the dosage forms included below may not apply to the brand name Viokace.
For the Consumer
Applies to pancrelipase: oral capsule, oral capsule delayed release, oral powder, oral tablet, oral tablet chewable
As well as its needed effects, pancrelipase (the active ingredient contained in Viokace) may cause unwanted side effects that require medical attention.
Major Side Effects
If any of the following side effects occur while taking pancrelipase, check with your doctor immediately:Incidence not known:
- difficulty breathing
- difficulty swallowing
- fast heartbeat
- hives, itching, or skin rash
- noisy breathing
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- tightness in the chest
- trouble passing stool
- unusual or severe abdominal or stomach pain
- unusual tiredness or weakness
Minor Side Effects
Some pancrelipase side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:More common:
- Acid or sour stomach
- stomach discomfort, upset, or pain
- difficulty having a bowel movement (stool)
- excess air or gas in the stomach or intestines
- full feeling
- passing gas
For Healthcare Professionals
Applies to pancrelipase: oral capsule, oral capsule extended release, oral delayed release capsule, oral powder for reconstitution, oral tablet, oral tablet extended release
In general, pancreatic enzymes are well tolerated at recommended therapeutic doses. Gastrointestinal symptoms appear to be the primary, and most common adverse effect.[Ref]
Fibrosing colonopathy should be suspected in patients who present with obstruction, bloody diarrhea, chylous ascites, or a combination of abdominal pain with chronic diarrhea, inadequate weight gain, or both. Patients with fibrosing colonopathy should have their enzyme dosage reduced to the recommended range of 500 to 2500 units/kg per meal. Surgical intervention is often needed in patients who cannot maintain their nutritional status.[Ref]
Gastrointestinal side effects have included cramping, nausea, abnormal feces, flatulence, abdominal pain, upper abdominal pain, and diarrhea, particularly with high doses. Fibrosing colonopathy has been reported. Animal studies suggest that the fibrosing colonopathy seen in some patients receiving high doses of pancreatic enzymes may be due to a plasticizer (methacrylic acid copolymer) found in some of the enteric coatings. Postmarketing reports have included abdominal distention, abdominal pain, diarrhea, flatulence, constipation, nausea, fibrosing colonopathy, and distal intestinal obstruction syndrome (DIOS).[Ref]
Metabolic side effects reported with high doses of pancreatic enzymes have included hyperuricosuria and hyperuricemia. It appears that both the enzyme product and some undefined aspect of the disease may lead to increased uric acid levels. Postmarketing reports of inadequate control of diabetes mellitus have been reported.[Ref]
Krasinger and colleagues suggest that it may be reasonable to add allopurinol to the pancreatic enzyme treatment regimen in CF patients that have a urine pH of less than 6 and also excrete large amounts of uric acid. The addition of allopurinol may help to protect the renal tubules from long-term damage due to uric acid crystallization.[Ref]
Hypersensitivity side effects have included reversible bronchial asthma and nasal rhinitis due to exposure to pancreatic enzyme powder. Postmarketing severe allergic reactions including anaphylaxis, asthma, hives and pruritus have been reported.[Ref]
Local side effects have included ulcerations and stomatitis after a prolonged retention of pancreatic enzyme formulations in the mouth.[Ref]
Nervous system side effects have included several case reports of elevation in intracranial pressure (leading to a bulging cranial fontanelle) in cystic fibrosis children receiving pancreatic enzymes. The adverse effect has been self-limiting without interruption of cystic fibrosis therapy in most cases.[Ref]
Postmarketing side effects include pruritus, urticaria and rash
Postmarketing side effects include recurrence of pre-existing carcinoma.
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2. "Product Information. Ultrase (pancrelipase)." Scandipharm Inc, Birmingham, AL.
3. "Product Information. Cotazym-S (pancrelipase)." Organon, West Orange, NJ.
4. "Product Information. Creon 10 (pancrelipase)." Solvay Pharmaceuticals Inc, Marietta, GA.
5. "Product Information. Zymase (pancrelipase)." Organon, West Orange, NJ.
6. "Product Information. Pancrease (pancrelipase)." McNeil Pharmaceutical, Raritan, NJ.
7. "Product Information. Creon 20 (pancrelipase)." Solvay Pharmaceuticals Inc, Marietta, GA.
8. "Product Information. Ultrase MT (pancrelipase)." Scandipharm Inc, Birmingham, AL.
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11. "Product Information. Cotazym (pancrelipase)." Organon, West Orange, NJ.
12. "Product Information. Viokase (pancrelipase)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
13. "Product Information. Creon 5 (pancrelipase)." Solvay Pharmaceuticals Inc, Marietta, GA.
14. McHugh K, Thomson A, Tam P "Case report: colonic stricture and fibrosis associated with high- strength pancreatic enzymes in a child with cystic fibrosis." Br J Radiol 67 (1994): 900-1
15. Kraisinger M, Hochhaus G, Stecenko A, Bowser E, Hendeles L "Clinical pharmacology of pancreatic enzymes in patients with cystic fibrosis and in vitro performance of microencapsulated formulations." J Clin Pharmacol 34 (1994): 158-66
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22. Sakula A "Bronchial asthma due to allergy to pancreatic extract." Lancet 2 (1977): 193
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24. Nasr SZ, Schaffert D "Symptomatic increase in intracranial pressure following pancreatic enzyme replacement therapy for cystic fibrosis." Pediatr Pulmonol 19 (1995): 396-7
It is possible that some side effects of Viokace may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.
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