Brom?line

Related Terms

Ananas comosus, Ananas sativus, Ananase?, Bromelain-POS, bromeline (pleural), Bromelainum, Bromeliaceae (family), Bromelin, Bromelins, Debridase, Phlogenzym (rutoside, bromelain, and trypsin), enzyme-rutosid combination, ERC (rutosid, bromelain, trypsin), plant protease concentrate, pineapple, pineapple extract, rutosid, Traumanase?, trypsin.

Background

Bromelain is a sulfur-containing proteolytic digestive enzyme that is extracted from the stem and the fruit of the pineapple plant (Ananas comosus, family Bromeliaceae).
When taken with meals, bromelain is believed to assist in the digestion of proteins. When taken on an empty stomach, it is believed to act medicinally as an anti-inflammatory agent.
The expert panel, the German Commission E, approved bromelain for the treatment of swelling/inflammation of the nose and sinuses caused by injuries and surgery in 1993.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


It is proposed that bromelain may be a useful addition to other therapies used for sinusitis (such as antibiotics) due to its ability to reduce inflammation/swelling. Studies report mixed results, although overall bromelain appears to be beneficial for reducing swelling and improving breathing. Better studies are needed before a strong recommendation can be made.

 B


It is proposed that bromelain may be a useful addition to other therapies used for sinusitis (such as antibiotics) due to its ability to reduce inflammation/swelling. Studies report mixed results, although overall bromelain appears to be beneficial for reducing swelling and improving breathing. Better studies are needed before a strong recommendation can be made.

 B


A bromelain-derived debriding agent, Debridase, has been studied on deep second degree and third degree burns with positive results. Further results are needed to confirm these results.

 C


A bromelain-derived debriding agent, Debridase, has been studied on deep second degree and third degree burns with positive results. Further results are needed to confirm these results.

 C


There is not enough information to recommend for or against the use of bromelain in the treatment of cancer, either alone or in addition to other therapies.

 C


There is not enough information to recommend for or against the use of bromelain in the treatment of cancer, either alone or in addition to other therapies.

 C


There is not enough information to recommend for or against the use of bromelain in COPD.

 C


There is not enough information to recommend for or against the use of bromelain in COPD.

 C


Bromelain is an enzyme with the ability to digest proteins. However, there is little reliable scientific research on whether bromelain is helpful as a digestive aid. Better study is needed before a firm conclusion can be made.

 C


Bromelain is an enzyme with the ability to digest proteins. However, there is little reliable scientific research on whether bromelain is helpful as a digestive aid. Better study is needed before a firm conclusion can be made.

 C


Several preliminary studies suggest that when taken by mouth, bromelain may reduce inflammation or pain caused by inflammation. Better quality studies are needed to confirm these results.

C


Several preliminary studies suggest that when taken by mouth, bromelain may reduce inflammation or pain caused by inflammation. Better quality studies are needed to confirm these results.

C


Bromelain may reduce mild acute knee pain in a dose-dependent manner.

C


Bromelain may reduce mild acute knee pain in a dose-dependent manner.

C


The effects of bromelain on muscle soreness following intense exercise are unclear.

C


The effects of bromelain on muscle soreness following intense exercise are unclear.

C


There is not enough information to recommend for or against the use of bromelain as a nutritional supplement.

 C


There is not enough information to recommend for or against the use of bromelain as a nutritional supplement.

 C


There is conflicting evidence on the effectiveness of bromelain to treat osteoarthritis. Further well-designed clinical trials of bromelain alone are needed to confirm these results.

 C


There is conflicting evidence on the effectiveness of bromelain to treat osteoarthritis. Further well-designed clinical trials of bromelain alone are needed to confirm these results.

 C


Bromelain may help treat skin rash. This treatment may be effective because bromelain has been shown to decrease inflammation, regulate the immune system, and have antiviral effects.

C


Bromelain may help treat skin rash. This treatment may be effective because bromelain has been shown to decrease inflammation, regulate the immune system, and have antiviral effects.

C


There is not enough information to recommend for or against the use of bromelain in rheumatoid arthritis (RA).

 C


There is not enough information to recommend for or against the use of bromelain in rheumatoid arthritis (RA).

 C


There is not enough information to recommend for or against the use of bromelain in the treatment of steatorrhea.

 C


There is not enough information to recommend for or against the use of bromelain in the treatment of steatorrhea.

 C


There is not enough information to recommend for or against the use of bromelain in urinary tract infections.

 C


There is not enough information to recommend for or against the use of bromelain in urinary tract infections.

 C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Dosing

Adults (18 years and older)
A variety of doses have been used and studied. Research in the 1960s and 1970s used 120 to 240 milligrams of bromelain concentrate tablets daily (Traumanase? or Ananase?; 2,500 Rorer units per milligram) in three to four divided doses for up to one week to treat inflammation. The German expert panel, the Commission E, has recommended 80 to 320 milligrams (200 to 800 FIP units) taken two to three times per day. Some authors recommend 500 to 1,000 milligrams of bromelain to be taken three times daily, and many manufacturers sell products standardized to 2,000 GDU in 500 milligram tablets. Effects of bromelain may occur at lower doses, and treatment may be started at a low dose and increased as needed.
Cream containing 35% bromelain in an oil-containing base has been applied to the skin to clean wounds.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Interactions

Interactions with Drugs
In theory, bromelain may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin?) or heparin, anti-platelet drugs such as clopidogrel (Plavix?), and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin?, Advil?) or naproxen (Naprosyn?, Aleve?). In addition, bromelain theoretically may add to the anti-inflammatory effects of NSAIDs.
Human studies suggest that bromelain may increase the absorption of some antibiotics, notably amoxicillin and tetracycline, and increase the levels of these drugs in the body. Bromelain may increase the actions of the chemotherapy (anti-cancer) drugs 5-fluorouracil and vincristine, although reliable scientific research in this area is lacking. In theory, use of bromelain with blood pressure medications in the "ACE inhibitor" class, such as captopril (Capoten?) or lisinopril (Zestril?), may cause larger drops in blood pressure than expected.
Some experts suggest that bromelain may cause drowsiness or sedation and may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan?) or diazepam (Valium?), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery.
Bromelain may also interact with heartbeat regulating medications, magnesium, and nicotine.

Attribution

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

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Brien S, Lewith G, Walker AF, et al. Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study. QJM. 2006 Dec;99(12):841-50.
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