If you take pancreatic enzymes, you already know. The pharmacy that always had your Creon now shrugs. Some are handing out one month at a time. This is not in your head and it is not your pharmacist being difficult. There is a real, global shortage of pancreatic enzyme replacement therapy, PERT, and it has run into 2026.
Here is what is going on and what you can actually do about it.
The short version of the cause: PERT is made from pig pancreas, the supply of that raw material has tightened, and demand has gone up. The result is patchy stock of Creon 10,000 and 25,000 capsules in particular, and pharmacies being asked to dispense smaller amounts so supply spreads further. The exact picture differs by country and changes month to month, so confirm your local situation with your own pharmacist.
What you can do, in order.
First, do not ration silently. The instinct when a medicine runs short is to skip doses and stretch the box. With PERT that backfires fast. Skip your enzymes and you stop absorbing fat, you lose weight you cannot afford to lose, and you slide into the fat-soluble vitamin deficiencies (A, D, E and K) the enzymes were protecting you from. If supply is the problem, the answer is a conversation with your team, not quietly halving your dose.
Second, understand how a brand switch actually works, because this is where people go wrong. The alternatives to Creon are Zenpep, Pancreaze, Nutrizym and Pertzye, among others. They are not interchangeable capsule for capsule. What matters is the number of lipase units, not the number of capsules. A 25,000-unit capsule of one brand is not automatically replaced by one capsule of another. So walk into the pharmacy or your appointment knowing your current dose in lipase units per main meal and per snack. With that one number, your prescriber or pharmacist can match you to an equivalent dose quickly and safely. Without it, everyone is guessing.
Third, protect the enzymes you have by spending your fat budget wisely, and notice that I said wisely, not “cut all fat.” You still need fat for calories and for those fat-soluble vitamins, so the aim is a leaner week, not a fat-free one. Enzymes do their hardest work on fat, so leaning on naturally low-fat meals means each capsule covers more of what you eat. The strict-phase staples earn their place here: poached chicken, white fish, plain rice, steamed vegetables.
Fourth, if a substitute brand does not seem to work as well, do not assume it has failed before you check two things with your team. Timing: enzymes work best taken with and through the meal, not all swallowed before it. And acid: stomach acid can break some enzymes down before they reach the small intestine, which is why a doctor may add an acid-reducing medicine such as a proton pump inhibitor to help the enzymes do their job. A switch that seems weak is sometimes a timing or acid problem, not a dud brand.
Stepan’s Rule: Never solve a shortage by skipping doses. Solve it with your dose number in lipase units, a phone call to your team, and a leaner fat week. Walk in knowing your number and the whole conversation gets faster.
Fifth, the practical housekeeping. Store enzymes somewhere cool and dry, because heat degrades them, so the glovebox in summer is a bad idea. Ask the pharmacist to flag you for the next delivery and to ring nearby branches, since stock sits unevenly across a city. And once supply returns, keep a small buffer within what your prescription allows. Reorder when you open your last box, not your last capsule.
This is a frustrating thing to live through, and none of it is your fault. It is a supply problem being solved slowly by manufacturers and regulators. Your job is to stay absorbing, stay fed, and keep your team in the loop.
If you want the full picture of how PERT works, how to time it across a meal, and how to talk to your team about dose, that is laid out properly in the book, with the framework I use myself.
Patient experience, not medical advice. Any brand or dose change goes through your prescriber.