UK Pharmacies Struggle with Severe Creon Shortage

Medscape

2 days ago

Nearly all UK pharmacies are experiencing severe 'challenges' supplying pancreatic enzyme replacement therapy (PERT), the National Pharmacy Association (NPA) warned.
A sample survey by the association found that 96% of pharmacies were struggling to obtain Creon (pancrelipase, Mylan). A further 89% reported difficulties supplying PERT alternatives.
Patients Resorting to Extreme Measures
The ongoing shortage has forced patients to take desperate action, according to the NPA, which said some are rationing existing medication supplies or skipping meals entirely.
One pharmacist described it as the 'worst stock shortage' they had ever encountered. Patients report eating only one meal daily, contacting multiple pharmacies for supplies, or travelling more than 30 miles to obtain the medication.
Critical Medication for Serious Conditions
Creon is used to treat pancreatic exocrine insufficiency from a variety of causes, including pancreatic cancer, cystic fibrosis, and pancreatitis.
The medication, derived from porcine pancreatin, contains lipase, protease, and amylase. It dissolves rapidly in the stomach to release its enzyme load in the small intestine, where its lipolytic, amylolytic, and proteolytic activity enable absorption of the products of pancreatic digestion.
PERT medications need to be taken to facilitate digestion every time a patient eats. In clinical trials, treatment with Creon markedly improved stool consistency, abdominal pain, and stool frequency, independent of the underlying disease.
The consequences of inadequate dosing can be severe. Patients may become too unwell for surgery, struggle with chemotherapy tolerance, or experience debilitating symptoms that diminish quality of life. Symptoms may include diarrhoea, flatulence, bloating, abdominal pain, unexplained weight loss, and oily, foul-smelling stools (steatorrhoea).
Safety Concerns
Olivier Picard, NPA chair, warned the shortage has 'profound effects' on patients who depend on the medication to survive and lead normal lives. 'It simply cannot be right that in the 21st century patients are skipping meals in order to ration their medication,' he said.
Last week, the government extended the current Serious Shortage Protocol (SSP) for Creon until 21 November 2025. The protocol allows pharmacists to use professional judgement to decide whether it's 'reasonable and appropriate' to substitute a patient's prescription for an alternative agent for one dispensing month. It allows pharmacies to supply a reduced quantity of Creon capsules that might be in stock, without having to send a patient back to their GP to get a new prescription.
Two SSPs for Creon 10,000 and 25,000 capsules have been in place since May 2024. However, the survey found that 81% of pharmacies felt the current arrangements for managing the shortage were inadequate. In particular, pharmacists were still obliged to refer patients back to prescribers when seeking PERT alternatives.
Alternative PERT formulations Nutrizym and Pancrex are also now in short supply as manufacturers struggle to meet demand.
GPs and pharmacies can order unlicensed Creon or other PERT products from overseas, but other countries have experienced similar shortages.
Calls for Regulatory Change
The NPA and Pancreatic Cancer UK issued a joint statement urging government action. They called for a national plan to address shortages and support patients with alternative care.
Picard said that although the situation was complex and not the fault of the government, medicine shortages were all too common. 'Highly trained pharmacists should also be permitted to use their professional judgment to supply alternative medicines — where it is safe and appropriate — in the event of the prescribed version being unavailable.'
Alfie Bailey-Bearfield, head of influencing and health improvement at Pancreatic Cancer UK, said that the findings were 'deeply worrying'.
It was 'totally unacceptable' that cancer patients were still taking desperate measures that put their health, wellbeing, and eligibility for treatment at risk, when the charity had been raising concerns with Department of Health and Social Care (DHSC) officials and PERT suppliers for more than a year. 'This crisis continues to put people's health on the line, and they cannot afford to wait any longer,' he said.
A DHSC spokesperson said that the supply issues with Creon were European-wide and caused by limited availability of raw ingredients along with manufacturing capacity constraints. 'We are working closely with industry and the NHS to mitigate the impact on patients and resolve the issues as quickly as possible,' the spokesperson said.