The review of the products from Republic of Moldova State Medicine Nomenclature used in treatment of exocrine pancreatic insufficiency

Abstract

Introduction. Exocrine pancreatic insufficiency (EPI) is characterized by maldigestion of nutrients and is caused by insufficient delivery of pancreatic digestive enzymes to the duodenum. The fact that the signs and symptoms aren’t specific, results in a late correct diagnosis and treatment. The management of EPI consists of taking digestive pancreatic enzyme medication during or immediately after the meals. The minimal dosage used when starting the therapy is between 40 000 and 50 000 USP units of lipase at each meal. An inadequate therapeutic response might be caused by the inactivation of lipase in the gastric acid if the medication doesn’t have a gastro-resistant coat. Aim of the study. To study the State Medicine Nomenclature and analyze the products suitable for treatment of EPI. Materials and methods. For this research were used: SNM, latest version including 6133 medications, international guides for gastrointestinal diseases and scientific articles. Results. Out of the 6133 products listed in the SNM, only 25 (0,4%) are drugs that contain pancreatic exocrine enzymes. From this 25: 21 (84%) contain only pancreatin, 3 (12%) – pancreatin combined with hemicellulose and bovine bile extract and 1 medication (4%) is a fusion of pancreatin, hemicellulose, bovine bile extract and simethicone. Only 6 products are with mini-microspheres, 16 have a gastro-resistant coat and 3 have an ordinary non-gastroresistant coat. According to the producing country, 52% are imported from Germany, 20% - from Ukraine, 16% - from Romania, 4% - from Turkey and only 8% are manufactured in Republic of Moldova. 5 drugs contain 25 000 USP units of lipase in each tablet/capsule, 6 products – 10 000 USP units of lipase each tablet and the other 14 medications have between 8 000 and 3 150 USP units of lipase in each pill. Currently, the following products can’t be found on the pharmaceutical market of Republic of Moldova: pancreatin + bile acids + plant extracts + antimicrobial constitutive and pancreatin + adsorbent agents. Conclusions. The diagnostic and initiation of treatment in patients with exocrine pancreatic insufficiency have to be done as soon as possible, in order to prevent the development of complications and maintain a high quality of life. The suitable drug and its dose has to be chosen for every patient individualy. The capsules with mini-microspheres seem to be the most effective from this group of medications, therefore the increase of such drugs would be welcomed on the pharmaceutical market of the country.