Creon 10000 Caution For Usage

Incompatibilities: Not applicable.
Special Precautions for Disposal and Other Handling: Administration through gastric tube (carefully test appropriateness of the selected syringe and tube).
Creon 10,000 can be administered via G-tube 16Fr and above, in most cases, if medically indicated. The pellet has a diameter of 0.7-1.6mm. It is important that the appropriateness of the selected syringe and tube is carefully tested. In order to maintain pellet integrity and to prevent clogging or sticking, the pellets should be mixed with a small amount of (thickened) acidic liquid or baby food (like apple sauce, fruit juice, sirupus simplex, full-fat yoghurt) (pH < 4.5) and the feeding tube should be flushed with water before and after administration of the mixture. Clogging was observed with certain brands of G-tube and baby food used.
1. Put a thickened acidic liquid (applesauce, baby food, sirupus simplex, full-fat yoghurt), with a "nectar thick" consistency into a small clean container (use 15mL of thickened liquid/applesauce per capsule).
2. Open the Creon 10,000 and add the contents (pellets) to the container. Stir gently to suspend contents evenly through the thickened acidic liquid.
3. If applicable, pause tube feeds and flush the G-tube with an appropriate amount of water (20-30ml of water).
4. Draw up the mixture from the container with an enteral syringe of appropriate size for the volume and feeding tube size.
5. Administer the mixture slowly through the feeding tube with slow-gentle pressure.
6. Flush the feeding tube with an appropriate amount of water (20-30ml) and resume tube feeds if applicable.
In case small bore G-tubes with ≤ Fr 12 are used or in case of clogging of G-tube, the uncrushed pellets can be mixed with 20ml of 8.4% sodium bicarbonate solution and allowed to dissolve (about 30 minutes). Subsequently administer the solution slowly through the feeding tube and flush the tube with water before and after each dose. With this method, there is, despite the buffering capacity of sodium bicarbonate, a certain risk of enzyme inactivation, yet tube occlusion is avoided.
For each 10,000 international units of lipase, about 800 mg of sodium bicarbonate is used. This is the amount provided by one 10-mL vial of 8.4% sodium bicarbonate solution.
Further information: The information in this monograph is limited. For further information, contact a doctor or pharmacist.