Products
Bromelain was commercially available in many countries in the form of dragées (Traumanase), and dietary supplements containing pineapple powder are available. Other drugs are approved abroad, for example, Wobenzym and Phlogenzym. Wobenzym is registered in many countries only in the canton of Appenzell Ausserrhoden.
Structure and properties
Bromelain is the name given to a preparation from the stems (fruit stalks) and fruits of the pineapple plant (, Bromeliaceae), which contains various proteolytic enzymes. Non-proteolytic components are also involved in the effect. Unlike other plants, the enzymes are still present in a relevant concentration even in the ripe fruits.
Effects
Bromelain (ATC M09AB03) has anti-inflammatory, anti-edematous, fibrinolytic, immunomodulatory, antitumor, antimicrobial, antiplatelet, and antithrombotic properties.
Indications for use
As an adjuvant in soft tissue inflammation with marked edema formation. Various other indications for use exist in other countries:
- Swelling, inflammation or pain as a result of injury.
- Inflammation of the urinary and genital tracts.
- Superficial phlebitis
- Osteoarthritis
- Soft tissue rheumatism
Approved in the EU as a gel (orphan drug):
- For removal of burn scab in adults with deep thermal injuries (NexoBrid).
Other indications are described in the literature. These include, in particular, cancer. Bromelain is also used as an herbal alternative to NSAIDs and glucocorticoids. In food technology, bromelain is used, among other things, like papain to tenderize meat.
Dosage
According to the package insert. The tablets are taken fasting, half an hour to an hour before a meal. The dosing interval depends on the drug.
Contraindications
- Hypersensitivity
- Blood clotting disorders
- Concurrent administration of anticoagulants or antiplatelet agents.
- Liver and kidney disease
- Before operations
- Children
- Pregnancy and lactation (not recommended)
Full precautions can be found in the drug label.
Interactions
Bromelain may promote absorption of other drugs and, in particular, increase plasma levels of antibiotics (eg, tetracyclines, sulfonamides, amoxicillin). An increased bleeding tendency with anticoagulants and antiplatelet agents cannot be ruled out.
Adverse effects
The most common potential adverse effects include allergic reactions and gastrointestinal symptoms.
