Viokace dosage – Forms, strengths, how to take & safety

If you're wondering how much Viokace you should be taking, the starting point is500lipase units perkg of body weight for each meal. Most adults end up on a dose between1500and2500U/kg/meal, never exceeding4000U of lipase pergram of fat consumed.

In this post we'll walk through the different tablet strengths, show you stepbystep how to calculate your dose, explain what a prescription looks like, and highlight the key benefits and risks so you can feel confident managing your exocrine pancreatic insufficiency (EPI) treatment.

What Is Viokace?

Viokace is a prescription pancreatic enzyme replacement that bundles lipase, protease, and amylase into one tablet. It's specifically approved for adults with EPI caused by chronic pancreatitis, pancreatic cancer, or after surgical removal of part of the pancreas. Because the enzymes are derived from porcine (pig) tissue, the product is regulated by the FDA as a "biological product" and carries a unique set of dosage recommendations that differ from other pancrelipase brands.

When used correctly, Viokace restores the body's ability to digest fats, proteins, and carbs, which can translate into weight gain, fewer greasy stools, and better overall nutrition. The drug is only available by prescription, so you'll need to see a gastroenterologist or a primarycare physician familiar with EPI to get a tailored dosing plan.

Viokace Tablet Strengths

Tablet strength	LipaseU	ProteaseU	AmylaseU	Imprint & Appearance
10440U	10440	39150	39150	Tan, round, "VIO9111"
20880U	20880	78300	78300	Tan, oval, "VIO9116"

Understanding these numbers is the first step toward a dose that actually works for you. The lipase component is the driver for the "U/kg" calculation, while the protease and amylase numbers let you know you're also getting protein and carbohydratedigesting power.

Most clinicians start patients on the 10440U tablets because they offer finer granularity when you're still figuring out how many units you need per meal. If you're heavier or have very highfat meals, the 20880U tablets can cut down the number of pills you need to swallow.

How To Take Viokace

Basic administration rules

Take Viokace with every meal or snack that contains fat, protein, or carbohydrate even a plain piece of toast counts. The tablet must be swallowed whole; chewing can damage the coating that protects the enzymes from stomach acid. Pairing the medication with a protonpump inhibitor (PPI) like omeprazole is also recommended, because a higherpH environment in the duodenum allows the enzymes to work more efficiently.

Dosing calculations stepbystep

1. Weigh yourself. Record your weight in kilograms (kg). If you usually see pounds, just divide by2.2.
2. Start with the baseline dose. Multiply your weight by500U of lipase. For a 70kg adult that's 35000U per meal.
3. Match the units to tablets. Using the strength table, each 10440U tablet gives you roughly 10440U of lipase. So 35000U 104403.3 tablets round to 3 or 4 tablets depending on tolerability.
4. Adjust based on response. If stools remain oily or you lose weight, increase by 250500U/kg/meal (roughly one extra tablet). If you experience abdominal pain or diarrhea, consider dropping a tablet.

Mealbymeal example

Let's say you've settled on 20880U tablets for a 75kg person. The calculation works out to about 37500U per meal, which equals roughly 2 tablets (220880=41760U). You could structure it like this:

• Breakfast 2 tablets
• Midmorning snack 1 tablet (half meal dose)
• Lunch 2 tablets
• Afternoon snack 1 tablet
• Dinner 2 tablets

Missed dose & dosedoubling warnings

If you skip a meal, simply wait until the next eating occasion and take the full dose then. Never double up on a missed dose doing so can push you over the safety threshold of4000U/gfat and increase the risk of fibrosing colonopathy.

Prescription & Insurance

Only a licensed prescriber can write a Viokace prescription. The typical order looks like this: "Viokace500U/kg/meal, max2500U/kg/meal, no more than4000U/gfat per day." Some insurers treat Viokace as a specialty medication, so a priorauthorization (PA) is often required.

Quick tip: ask your doctor to include the exact strength and dosing schedule on the prescription; that can smooth the pharmacy's verification process. If you run into a PA roadblock, many pharmacies will help you draft a justification letter that references the FDA prescribing information and the clinical need for enzyme replacement.

Safety: Benefits & Risks

Expected benefits

When the dose is right, you'll notice a dramatic reduction in steatorrhea (fatty stools) and an improvement in weight stability. Clinical trials show that Viokace can raise the coefficient of fat absorption (CFA) from about48% to86%a huge leap for anyone struggling with malnutrition.

Common side effects

System	Frequency	Examples
Gastrointestinal	7%	Anal itching, abdominal cramping, gas, bloating
Hepatobiliary	7%	Biliary tract stones
Skin	<5%	Rash, pruritus

Serious warnings fibrosing colonopathy

This rare but serious condition has been linked to doses exceeding6000U/kg/meal, especially in children. For adults, the consensus ceiling is2500U/kg/meal unless a physician can demonstrate a clear benefit through stoolfat testing. Staying below that limit reduces the chance of the colon's fibrous thickening, which can lead to obstructive symptoms.

Other cautions

• Hyperuricemia/gout. Enzyme preparations contain purines that can raise uric acid levels.
• Allergy to porcine proteins. If you're allergic to pork, Viokace isn't an option.
• Lactose content. The tablets use lactose monohydrate as a filler a concern for people with severe lactose intolerance.
• Pregnancy & breastfeeding. Systemic absorption is minimal, but always discuss the risk/benefit ratio with your OBGYN.

Monitoring & followup

Regular followup appointments should include stoolfat analysis, weight checks, and a review of any new symptoms. Lab work (uric acid, liver and kidney panels) may be ordered if you're on a higher dose for an extended period. Your doctor will also want to know if you've started a new PPI or changed your diet, as those factors can shift the optimal Viokace dosage.

Practical Tips & Experience

Realworld example

Maria, a 58yearold teacher with chronic pancreatitis, began Viokace at 500U/kg/meal. Within two weeks, her greasy stools dropped from three per day to almost none, and she gained three pounds. She kept a simple dosing log in her phone, noting the number of tablets, meal fat content, and any side effects. By monthfour, her doctor nudged the dose up to 1200U/kg/meal to match her more "cheeseheavy" diet, and Maria continued to thrive.

Storage & handling

Store Viokace at room temperature (2025C) in a dry place. Keep the original bottle tightly sealed to protect the tablets from moisture. The little desiccant packet inside isn't for eating discard it after opening.

Travel & onthego dosing

Pack your tablets in a small pill organizer and bring a bottle of water. If you travel internationally, remember that the PPI you rely on might have a different brand name; ask your pharmacist for the generic name (omeprazole, esomeprazole) so you can pick it up abroad.

When to call your doctor

Reach out if you notice any of the following:

• New or worsening abdominal pain
• Persistent diarrhea despite dose adjustments
• Signs of gout (painful joints, swelling)
• Any allergic reaction rash, swelling of lips or tongue
• Unexplained weight loss or failure to gain weight

Early communication can prevent complications and keep your treatment on track.

BottomLine Takeaways

Viokace dosage isn't a "onesizefitsall" number. It starts at500lipaseUperkg of body weight for each meal, and you can safely titrate up to2500U/kg/meal while watching the fatpergram limit. The two tablet strengths10440U and 20880Ulet you finetune each dose, and pairing the medication with a protonpump inhibitor maximizes its effectiveness.

Balancing the impressive nutritional benefits with the rare but serious risks (like fibrosing colonopathy) is where your physician's expertise shines. Keep a dosing log, stay in touch with your healthcare team, and don't hesitate to ask questions. With the right guidance, Viokace can turn a chaotic, greasystool routine into a smoother, healthier daytoday life.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.