Adding Viokace to Formula or Human Milk

These instructions are for Children's Hospital of Philadelphia (CHOP) patients with cystic fibrosis (CF) who need Viokace® pancreatic enzymes added to formula or human milk.

Important information:

• Most children who have cystic fibrosis need to take pancreatic enzymes. These replace the natural enzymes that are blocked by thick mucus in the tubes of the pancreas. Learn more about cystic fibrosis (CF).

• Viokace (vye-oh-kase) is a pancreatic enzyme that breaks down fats, proteins, and carbohydrates. Viokace is used to help digest the nutrients in formula or human milk.

• Your healthcare provider has prescribed a specific dose for your child. Each child is different, so your child will need their own plan for enzymes.

• The dose is determined by several factors including your child's weight and fat content of the formula or human milk.

• Only give your child the Viokace dose prescribed by your healthcare provider. This will match the Viokace dose printed on the prescription label.

• Viokace is available from your local pharmacy or a mail-order pharmacy. It is usually available within 1 to 2 days of ordering. Be sure to allow enough time for ordering when you refill your prescription.

Instructions for giving Viokace enzymes:

Do not mix crushed Viokace into formula that is taken by mouth. Only give it through a feeding tube.

1. Gather your supplies:

   • Viokace tablets

   • Pill crusher

   • 2 Medicine cups

   • Small spoon

2. Wash hands with soap and water or use hand sanitizer.

3. Remove the correct number of tablets for your child's dose from the bottle.

4. Use a pill crusher to crush tablets into a very fine powder.

5. 

   Viokace comes in two different doses. Follow the steps below for the type of tablet prescribed for your child:

   • The round tablet has a dose of 10,440 units.

     • For each crushed round tablet, add 2.5 mL of water.

     • For example, if your child gets one tablet add 2.5 mL of water. If they get 2 tablets, add 5 mL of water (2.5 mL + 2.5 mL).

   • The oval tablet has a dose of 20,880 units.

     • For each crushed oval tablet, add 5 mL of water.

     • For example, if your child gets one tablet, add 5 mL of water. If they get 2 tablets, add 10 mL of water (5 mL + 5 mL).

6. Use a medicine cup or oral syringe to measure the correct amount of water (described above) to mix with crushed tablets.

7. Combine water and Viokace in a separate medicine cup. Stir Viokace with water for 30 seconds to create a smooth, milky-looking mixture. There should not be any large pieces of Viokace tablet remaining.

8. Allow mixture to sit at room temperature until powder is dissolved (this may take up to 15 minutes).

9. Prepare and prime your child's feeding bag with formula or human milk as you have been taught.

10. Add Viokace mixture to the bag that contains your child's formula or human milk.

    • It may be difficult to transfer all of the Viokace mixture into the feeding bag. To remove any leftover Viokace, rinse medicine cup with another 10 mL of water and add to the feed if needed

11. Gently massage feeding bag for 15 seconds so the Viokace gets mixed throughout the bag.

12. Allow Viokace to sit still in formula or human milk for 15 minutes before starting the feeding. This allows the enzymes to break down nutrients.

13. After 15 minutes, your child's Viokace treated formula or human milk is ready to be given through their feeding tube. Once the Viokace mixture is added to the formula or human milk, the feed should be started through your child's feeding tube within 30 minutes.

Contact your healthcare provider who orders your medicines with any questions.

Reviewed on July 1, 2022, by Laura Padula, RD