Surgery, Sprains and Strains, and Tendinitis

Overview

Bromelain is a mixture of enzymes that digest protein (proteolytic) that are found in pineapples (Ananas comosus). Pineapple has been used for centuries in Central and South America to treat indigestion and reduce inflammation. Bromelain, which is derived from the stem and juice of the pineapple, was first isolated from the pineapple plant in the late 1800s. The German Commission E approved bromelain to treat swelling and inflammation after surgery, particularly sinus surgery.

Bromelain can be used to treat a number of conditions, but it is particularly effective in reducing inflammation from infection and injuries.

Surgery, Sprains and Strains, and Tendinitis

Although studies show mixed results, bromelain may reduce swelling, bruising, healing time, and pain after surgery and physical injuries. It is often used to reduce inflammation from with tendinitis, sprains and strains, and other minor muscle injuries. Studies of people having dental, nasal, and foot surgeries found it did reduce inflammation. In Europe, bromelain is used to treat sinus and nasal swelling following ear, nose, and throat surgery or trauma.

Wounds and Burns

Some studies of animals suggest that bromelain, when applied to the skin, may be useful in removing dead tissue, a process called debridement, from third-degree burns. One preliminary study using a debridement agent that is derived from bromelain to treat people with second- and third-degree burns showed a benefit. Severe burns require a doctor’s care. Do not apply bromelain to broken skin.

Sinusitis (Sinus inflammation)

Although not all studies agree, bromelain may help reduce cough and nasal mucus associated with sinusitis, and relieve the swelling and inflammation caused by hay fever.

Arthritis

Studies show mixed results, but one study suggested that a combination of bromelain, rutosid, and trypsin worked as well as nonsteroidal anti-inflammatory drugs, which are commonly used pain relievers, for reducing knee pain from osteoarthritis. NSAIDs include ibuprofen (Advil or Motrin), naproxen (Aleve), and diclofenac (Voltaren), among others.

Some early studies suggest that bromelain may also help reduce pain in people with rheumatoid arthritis, but the results are not certain.

Infection

Some evidence from test tube and animal studies suggests that bromelain can kill some viruses and bacteria. But more research, including human studies, is needed to see whether it truly works.

Dietary Sources

Bromelain is found in the common pineapple plant, but not in high enough doses to act as medicine.

Available Forms

Bromelain is available in tablet or capsule form for use by mouth. A topical variety is sometimes used by health care providers to treat severe burns. You should never try to treat a severe burn yourself. Always see a health care provider.

How to Take It

Pediatric

Don’t give bromelain to a child. There are no studies to know if it’s safe or not.

Adults

The German Commission E recommends 80 - 320 mg 2 - 3 times per day. For specific conditions, higher doses may be prescribed:

·  Digestive aid: 500 mg per day in divided doses with meals

·  Injuries: 500 mg 4 times a day on an empty stomach

·  Arthritis: 500 - 2,000 mg a day in two divided doses

Precautions

Because supplements may have side effects or interact with medications, you should take them only under the supervision of a knowledgeable health care provider. Bromelain is generally recommended for no longer than 8 - 10 days in a row.

Side effects from bromelain are generally mild and include nausea, vomiting, diarrhea, and excessive menstrual bleeding.

People who are allergic to pineapples, wheat, celery, papain, carrot, fennel, cypress pollen, or grass pollen may also be allergic to bromelain.

Pregnant women and people with bleeding disorders, high blood pressure, and liver or kidney disease should not take bromelain.

Bromelain may increase the risk of bleeding during and after surgery. You should stop taking bromelain at least 2 weeks before surgery.

Possible Interactions

If you are being treated with any of the following medications, you should not use bromelain without talking to your health care provider.

Antibiotics-- Bromelain may increase the amount of antibiotics absorbed by the body. In one clinical study, the combination of bromelain and amoxicillin raised the levels of amoxicillin in the blood. Also, some studies suggest that bromelain may increase the body's absorption of tetracycline, another antibiotic. But results of other studies have been conflicting.

Blood-thinners (anticoagulants and antiplatelet drugs)-- Bromelain may affect the blood's ability to clot. When taken with blood-thinners, it could raise the risk of bleeding. Some blood-thinning drugs include:

·  Warfarin (Coumadin)

·  Clopidogrel (Plavix)

·  Aspirin

Sedatives-- Some experts believe bromelain may make sedative drugs stronger, including:

·  Anti-seizure medications, such as phenytoin (Dilantin) and valproic acid (Depakote)

·  Barbiturates

·  Benzodiazepines, such as alprazolam (Xanax) and diazepam (Valium)

·  Drugs to treat insomnia, such as zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta), and ramelteon (Rozerem)

·  Tricyclic antidepressants, such as amitriptyline (Elavil)

·  Alcohol

The same is true of herbs with a sedating effect, such as valerian, kava, and catnip.

Supporting Research

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