Side effects?

Question

Hello dear experts,

My son (3,5 years old) has had two positive sweat tests; a gene test is still outstanding.

We have been given Creon® (pancrelipase) and multivitamins, which I think are quite effective. Since our son has been taking both, he does not want to go to sleep, has become almost hyperactive and is sometimes very aggressive.

Could this be side effects?

Many thanks for your answer.

Answer

Hello,

Pancreatic enzyme replacement therapy in patients with disturbed pancreatic function improves the nutritional condition and physical growth in patients with cystic fibrosis (CF). About 85% of CF patients have a dysfunctional pancreas. I assume that, apart from the sweat test, the pancreatic function was also tested by determining the elastase concentration. If the pancreatic function is disturbed, your son needs enzyme replacement therapy (e.g. with Creon®/pancrelipase, which you mention). There are several compounds with comparably good results and comparable side effects. It is recommended to substitute liposoluble vitamins (A, D, E and K). For some vitamins, it makes sense to determine their levels. Concerning the enzyme therapy, side effects such as abdominal pain (occurring often) and constipation, abnormal stool, diarrhoea, and nausea/vomiting (all of them occurring occasionally) have been described after intake. Could stomach ache possibly be one reason for your son’s sleeping problems? Children who have trouble sleeping can be aggressive as a result. It would certainly make sense to further clarify this.

Please also consider the immense emotional burden for the family if the diagnosis is rather new. This also affects your son. Please talk about your worries at your CF centre.

Kind regards,
Dr. Olaf Eickmeier

13.08.2013