Use of a New Delayed Release Pancrelipase Formulation to Clear Obstructed Feeding Tubes

Abstract

Obstructed feeding tubes remain a challenge for health care providers. Loss of feeding access can be detrimental to the patient's health and quality of life while increasing health care expenditures. Pancrelipase, which consists of various quantities and strengths of the digestive enzymes amylase, lipase, and protease, has long been used as an effective means for clearing feeding tubes. However, due to regulations from the US Food and Drug Administration (FDA), several formulations of pancrelipase including an immediate release crushable formulation (Viokase, Axcan Pharma, Birmingham, Alabama) have been removed from the market, leaving only delayed release formulations available that have not been tested for this purpose. Until an immediate release pancrelipase formulation is FDA approved and can be made available, clinicians have limited options and little guidance on how to clear obstructed feeding tubes. This case series highlights the clinical dilemma created by the FDA-mandated withdrawal of Viokase and describes our observations of several health care providers in our medical center using various strengths of a new delayed release pancrelipase formulation (Zenpep, Eurand Pharmaceuticals, Yardley, Pennsylvania) to clear obstructed feeding tubes.