Digestive Enzymes (PERT) Shortage Report - Canada, Fall of 2026
I'm writing this entry to state the obvious: there is a shortage of PERT, as a result of a global shortage of a raw material that is causing strain on the supply chain.
I can already feel the effects of lowering my dosage of prescription digestive enzymes or PERT (Pancreatic Enzyme Replacement Therapy).
I have that old familiar pain on the right side of my neck that is starting to bother me. It's kind of like I have a kink in my neck, but it seems to run up and down from the base of my skull, down the neck and into the shoulder there. Ah, yes, the old familiar referred pain that I discuss in my most popular blog entry here.
This is only one of the many symptoms of EPI that I will experience.
Other symptoms of Exocrine Pancreatic Insufficiency include:
Bloating and gas
Diarrhea
oily, pale, foul-smelling, floaty stools that are hard to flush (steatorrhea)
abdominal cramps/pain radiating to the back
nutritional deficiencies (like fat-soluble vitamins A,D,E,K)
weight loss/failure to thrive
fatigue, weakness, muscle loss
bone pain/ osteoporosis
night blindness or other vision problems related to vitamin A deficiency
brittle nails, hair loss, dry skin, or bruise - prone
edema
anemia
less commonly mentioned is constipation, as food isn't digested and just sits in the digestive system
The reason I've lowered my dose recently is certainly not by choice; it is by force, because of this shortage. As many here know, I've been advocating for years for patients to take enough enzymes when dealing with EPI or Exocrine Pancreatic Insufficiency, which is just a fancy way of saying that the pancreas isn't producing enough digestive enzymes to break down food that we eat into nutrients that our cells need.
I went to renew my prescription for Cotezym ECS 20, (the highest dose they make), something that I've been using for nearly 20 years to live. I need to take at least 3-5 of these per meal to absorb nutrients, avoid constant pain, and digest my food. I was told by my local pharmacy that the meds I need to live - are on backorder.
Don't panic; I thought back to 2023 when there was a shortage before. I was able to order them from Costco back then. So I called my trusty Costco. They told me the drugs were on backorder. They did have some in stock, but not enough to fill my usual prescription. I asked them to fill those for me, but I was feeling uneasy about the news.
I've mentioned before that my brother and I have the same genetic condition that causes tumours to form in the pancreas: MEN1, and that is why my brother had his entire pancreas, gallbladder and spleen removed several years ago. His body doesn't make ANY of these vital enzymes: amylase, protease, or lipase to break down carbohydrates, protein, or fats, respectively. I have 20% of my pancreas left after my distal pancreatectomy and splenectomy, so I make very, very little of these.
Other people who use PERT, besides people with surgical removal of the pancreas, include people with Cystic Fibrosis, where the pancreatic ducts can become blocked with thick mucus; people with chronic pancreatitis, pancreatic cancer and neuroendocrine cancer; some people with Diabetes; Shwachman-Diamond Syndrome; celiac disease (also me); bariatric or GI surgery; HIV, and aging.
The effects of a shortage like this can have devastating effects besides the symptoms I've already mentioned, as not only is this causing anxiety among those of us who need this to live, but it can cause life-threatening events, both acute and chronic. Hypoglycemia, weight loss, being unfit to undergo cancer treatments, or other life-saving therapies or surgeries due to weakness. The list goes on.
Why is there a shortage? This was my burning question as I began calling around to pharmacies in a 50 KM radius to look for more PERT. The pharmacists couldn't tell me, so I turned to the interwebs:
It seems as though this is a perfect storm that started in 2023, when the UK product Pancrease HL (Janssen-Cilag) was discontinued for "commercial reasons". They say this is the event that triggered the demand spike on Creon and, subsequently, other brands.
Digestive enzymes cannot be synthesized. I personally see this as proof of a divine creator (my blog, I can say this). So they harvest them from the pancreas of pigs that have already been harvested for food. Interesting and a bit gross lol! Why not other animals? Well, they say pigs are the closest animal biologically to humans. They produce the closest profile of enzymes that we do, as their diets can be arguably similar to ours (omnivores). Other animal, bacterial, and fungal enzymes are being studied, but for now, this is the only thing we've got that is proven and tested.
So why the shortage? Interestingly, the demand for pork that humans eat has increasingly shifted to leaner animals. This means that the actual diets of the pigs have changed, and the enzyme profile and production of the pigs have changed, requiring more pig pancreas cells to produce the same strengths as usual. This creates a finite supply of raw materials.
There have been some manufacturing capacity limits. Creon is now the most popular brand of prescription digestive enzymes. The company that distributes these, Viatris, has stated it has reached maximum manufacturing output. The places that turn the biologically active substance, pancrelipase, into pharmaceutical-grade powder (we will call API) used for Western markets, are located primarily in Germany and the USA and just don't seem to have enough to go around. I'm reading that there is another place that is supposed to be making more API (Active Pharmaceutical Ingredient) in Germany and is supposed to be online soon. This, we are all hoping, will be what is needed to fix this ongoing global issue by the spring of 2027.
There is increasing demand for these medications. More and more people are not only being diagnosed with the conditions that cause EPI, but more and more people are living longer WITH these conditions because of advances in medicine.
It is speculative on my part here; I would have to dig to see if there is scientific proof, but I have noticed a drastic uptick in membership requests to join my support group for pancreas surgery since COVID. Some believe the virus had an ill effect on pancreases around the world. My other speculation is the huge increase in GLP-1 agonist meds that ask the pancreas to produce more substances. As I said, these are my own ideas.
What can we do?
The best way to manage this situation is to contact your prescriber right away. Don't wait until you run out of product. Ask them if they have the product that you take in stock now.
If not, ask them to check with the distributor to see if there's stock in the warehouse.
If those don't work, this part is key because it is the one that my pharmacists have been missing, and had they done this, all of my anxiety over this issue may have been resolved much quicker: The pharmacist must themselves phone the manufacturer of the product to get information on how to get you your product.
Call Viatris Canada for Creon products at 1-800-575-1379. I found Viatris very hard to contact today as their lines were down but I finally got through, and the customer service agent said product would be in the warehouse by next week!
Call Organon Canada for Cotezym Products at 1-800-663-1326. They're only open until 5pm EST, so get your pharmacist to get them early. When I dialled this number myself, I didn't receive an answer but a prompt to leave a message. This is what your pharmacist will have to do, according to the customer service rep I spoke with today. She said for Cotezym patients there should be no reason for people to be going without their meds as long as the pharmacist is calling them to get the order.
I didn't go on to get the manufacturer of Pancrease MT 16 or Viokace but same deal if needed; these are the 4 manufacturers of PERT that are approved for use in Canada.
Next steps if that doesn't work:
Call around to different pharmacies near you and see if there is anything in stock that you can have filled. You may need to move your prescription around to get something. See my note at the end of this entry to learn about possible Insurance issues with this.
Ask your prescriber to provide you with more prescriptions for each of the equivalents with the correct doses for you to keep on file for future shortages.
Remember who else is using these. Children with Cystic Fibrosis are some of the largest beneficiaries, followed by people with no pancreas at all. After watching what has been happening in the UK over the past number of years, they have had to implement ways to triage who gets what. It is very important that we don't hoard the meds for ourselves while other people are also desperate to get them. Children and people with no exocrine production at all are at the highest risk.
Learning about this issue has really opened my eyes as to what people have endured globally as this shortage has been going on. I really hope that patients in Canada do not end up out of these medications after seeing the patient stories and advocacy they've been doing in the UK. There is information and a short film that was made for prescribers in the UK on how to deal with the shortages that mentions what to do if patients cannot obtain ANY PERT, and certainly, I suppose, this is something that should be considered if things ever get that bad. It mentions things like rationing capsules/eliminating one capsule per day or meal, but certainly this isn't something that we should be doing when suffering from EPI. The effects of not taking enough enzymes can be devastating for people who need it. Other things mentioned are limiting fat and fibre intake and more extreme measures, but NONE of these should even be considered without a physician's oversight. I implore anyone who is having trouble getting the meds they need to contact their physician as soon as possible to get a solution figured out.
The good news is that after calling around, I've discovered that the shortage is not a Tier 3, meaning that there is supply for everyone, but it might be a bit strained until spring.
I find it strange that there's hardly been any mention on any official pages in Canada about this shortage. I know for me personally, over the past few years, this is the first time that this shortage has actually affected me. I hope the time between now and the spring when they anticipate an end to this shortage, is easier for people to navigate this issue.
Looking at the UK and all that they have endured and advocated for has helped the whole world deal with this. I found many resources and statements and protocols on what to do if you're in the UK with a PERT shortage: https://www.psgbi.org/position-statement-pert-shortage/
But I have not seen anything for Canada, except the website Health Product Shortages:
To find out more about what Health Canada is doing about drug shortages in general, visit: https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/drug-shortages/plan-2024-2028.html
I'll end this by mentioning what I learned about insurance coverage for these meds. This is my own experience as an Alberta, Canadian resident.
When I obtained what I could get from my regular pharmacy, which was only10 days' worth of Cotezym ECS 20, it was counted as one transaction as per my drug benefit insurer. Normally, one transaction would be a 90-day supply, so I've never come across this issue before. So when I found another 20-day supply at a different pharmacy and had them transfer my prescription over there to fill it, my insurer would NOT cover this transaction, even though I was only ending up with a 30-day supply instead of my regular 90-day supply. The REASON for this, as told to me after contacting the benefit company, was because of the "2/3 rule". This rule, I verified, is this particular company's rule and is enforced by them. I asked for it to be explained to me:
On September 23, 2026, I obtained a 10-day supply (in one transaction; this is the crux), so the benefit company says that to get any more of that drug, I have to wait 2/3 of 10 days before they will cover more. So 10 days x 0.67 is 6.7 or 7 days have to pass before I can obtain more. They do not care if the supply of the medication will be filled by other people in the meantime; this is the rule. The only way around the rule, I'm told by this particular company, would be to pay full price out of pocket for the drug and submit for reimbursement so they will have to manually process the transaction and pay me back. I don't know about you, but economic times in Canada right now don't exactly lend themselves to me being able to pay for these meds out of pocket.
So keep this information in mind if you find yourself having to move your prescription around to obtain product.
So I'm very encouraged that there seems to be some relief coming when some of the Creon is in warehouses again next week.
I hope that everyone reading this is able to find this information helpful and remember that there will be enough product to go around if we are all responsible and don't stock more than we need.
