Bromelain

Bromelain/Drug Interactions:

  • AnalgesicsAnalgesics: In human study, bromelain has been shown to have pain-reducing properties (54; 41; 55). The effects with other analgesic agents are not clear.
  • Antiarthritic agentsAntiarthritic agents: Bromelain contains proteolytic enzymes, which have displayed anti-inflammatory and analgesic properties in human and laboratory studies. It has been shown to increase fibrinolytic activity and indirectly inhibit pro-inflammatory prostaglandins (56; 44; 31; 57). The effects with antiarthritic agents are not clear.
  • Antiasthma drugsAntiasthma drugs: Based on case reports, bromelain may cause some difficulty in breathing and hyper-allergenic responses, such as asthma (37), bronchospasms (49), and bronchial obstruction (52). Cases of bromelain-induced occupational bronchial asthma have been identified in laboratory workers (51).
  • AntibioticsAntibiotics: Based on human study, bromelain may increase the absorption of some antibiotics, notably amoxicillin and tetracycline, and increase levels of these drugs in the body (58; 59; 60; 61). However, in one study, there was no effect on absorption of tetracycline when patients were coadministered 80mg bromelain with 500mg tetracycline (62).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Based on in vitro, animal, and human study, bromelain may increase serum prothrombin time, plasma antithrombin time, and serum plasmin concentration (38), reduce platelet sensitivity to adenosine diphosphate (ADP) (39), and decrease platelet count (4). During cataract removal surgery, mild operative hemorrhage has occurred (28). Theoretically, bromelain may increase the risk of bleeding when taken with anticoagulants or antiplatelets.
  • Antigout agentsAntigout agents: Based on secondary sources, bromelain may have antigout effects. However, in clinical study, no response to bromelain therapy was seen in gout patients in terms of reduction of swelling and increased mobility (31).
  • AntihypertensivesAntihypertensives: Based on animal study, bromelain may have hypotensive effects (57); however, human study has found no effect (34). The effects of bromelain with antihypertensive agents are not well understood.
  • Anti inflammatory agentsAnti inflammatory agents: Bromelain contains proteolytic enzymes, which have displayed anti-inflammatory and analgesic properties in human and laboratory studies. It has been shown to increase fibrinolytic activity and indirectly inhibit pro-inflammatory prostaglandins (56; 44; 31; 57). The effects with other anti-inflammatory agents are not clear.
  • Antineoplastic agentsAntineoplastic agents: Bromelain has been found to induce cytokine production and suppress cell growth in cancer cells (63; 64). The effects with antineoplastic agents are not well understood.
  • Cardiovascular agentsCardiovascular agents: In human study, bromelain (Anavit-F3?, containing 230mg of bromelain of 1,200 gelatin digestion units per gram and 15mg of ascorbic acid), in recommended doses, did not have any effect on heart rate in hypertensive patients (34). However, when the dose was increased eight-fold, there was a proportional increase in heart rate, but not in blood pressure. Caution is warranted when using bromelain with agents that regulate heart rate.
  • Heart rate regulating agentsHeart rate regulating agents: In human study, bromelain (Anavit-F3?, containing 230mg of bromelain of 1,200 gelatin digestion units per gram and 15mg of ascorbic acid), in recommended doses, did not have any effect on heart rate in hypertensive patients (34). However, when the dose was increased eight-fold, there was a proportional increase in heart rate, but not in blood pressure. Caution is warranted when using bromelain with agents that regulate heart rate.
  • ImmunosuppressantsImmunosuppressants: Based on preliminary study, bromelain may have immunomodulatory activity. Based on case reports, bromelain has been shown to cause IgE-mediated reactions (51). In animal study, bromelain treatment resulted in reduced total BAL leukocytes, eosinophils, CD4+ and CD8+ T lymphocytes, CD4+/CD8+ T cell ratio, and IL-13 (5). Bromelain had synergistic effects and increased the immunomodulatory effects when used in combination with interferon gamma (63).
  • InterferonsInterferons: Bromelain had synergistic effects and increased the immunomodulatory effects with used in combination with interferon gamma (63).
  • Magnesium supplementsMagnesium supplements: Based on secondary sources, magnesium acts as a reducing agent, which may lead to activation of bromelain.
  • SedativesSedatives: Based on secondary sources, bromelain may increase the effect of sedative or hypnotic medications.

    • Bromelain/Herb/Supplement Interactions:

  • AnalgesicsAnalgesics: In human study, bromelain has been shown to have pain-reducing properties (54; 41; 55). The effects with other analgesic agents are not clear.
  • Antiarthritic herbs and supplementsAntiarthritic herbs and supplements: Bromelain contains proteolytic enzymes, which have displayed anti-inflammatory and analgesic properties in human and laboratory studies. It has been shown to increase fibrinolytic activity and indirectly inhibit pro-inflammatory prostaglandins (56; 44; 31; 57). The effects with antiarthritic agents are not clear.
  • AntibacterialsAntibacterials: Based on human study, bromelain may increase the absorption of some antibiotics, notably amoxicillin and tetracycline, and increase levels of these drugs in the body (58; 59; 60; 61). However, in one study, there was no effect on absorption of tetracycline when patients were coadministered 80mg bromelain with 500mg tetracycline (62).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Based on in vitro, animal, and human study, bromelain may increase serum prothrombin time, plasma antithrombin time, and serum plasmin concentration (38), reduce platelet sensitivity to adenosine diphosphate (ADP) (39), and decrease platelet count (4). During cataract removal surgery, mild operative hemorrhage has occurred (28). Theoretically, bromelain may increase the risk of bleeding when taken with anticoagulants or antiplatelets.
  • Antigout herbs and supplementsAntigout herbs and supplements: Based on secondary sources, bromelain may have antigout effects. However, in clinical study, no response to bromelain therapy was seen in gout patients in terms of reduction of swelling and increased mobility (31).
  • Anti inflammatory herbs and supplementsAnti inflammatory herbs and supplements: Bromelain contains proteolytic enzymes, which have displayed anti-inflammatory and analgesic properties in human and laboratory studies. It has been shown to increase fibrinolytic activity and indirectly inhibit pro-inflammatory prostaglandins (56; 44; 31; 57). The effects with other anti-inflammatory agents are not clear.
  • AntineoplasticsAntineoplastics: Bromelain has been found to induce cytokine production and suppress cell growth in cancer cells (63; 64). The effects with antineoplastic agents are not well understood.
  • Cardiovascular herbs and supplementsCardiovascular herbs and supplements: In human study, bromelain (Anavit-F3?, containing 230mg of bromelain of 1,200 gelatin digestion units per gram and 15mg of ascorbic acid), in recommended doses, did not have any effect on heart rate in hypertensive patients (34). However, when the dose was increased eight-fold, there was a proportional increase in heart rate, but not in blood pressure. Caution is warranted when using bromelain with agents that regulate heart rate.
  • HypotensivesHypotensives: Based on animal study, bromelain may have hypotensive effects (57); however human study has found a lack of effect (34). The effects of bromelain with antihypertensive agents are not well understood.
  • ImmunosuppressantsImmunosuppressants: Based on preliminary study, bromelain may have immunomodulatory activity. Based on case reports, bromelain has been shown to cause IgE-mediated reactions (51). In animal study, bromelain treatment resulted in reduced total BAL leukocytes, eosinophils, CD4+ and CD8+ T lymphocytes, CD4+/CD8+ T cell ratio, and IL-13 (5). Bromelain had synergistic effects and increased the immunomodulatory effects when used in combination with interferon gamma (63).
  • MagnesiumMagnesium: Based on secondary sources, magnesium acts as a reducing agent, which may lead to activation of bromelain.
  • NicotineNicotine: In clinical study, one patient quit smoking because tobacco reportedly tasted bad following bromelain administration (23).
  • SedativesSedatives: Based on secondary sources, bromelain may increase the effect of sedative or hypnotic medications.
  • SoySoy: Based on secondary sources, soybean protein may lead to the inhibition of bromelain activity.
  • Trypsin containing herbs and supplementsTrypsin containing herbs and supplements: Based on animal study, bromelain and trypsin may have a synergistic effect (65). Bromelain may react with other proteases like papain, some grass pollens, and wheat and rye flour (66; 67).
  • ZincZinc: Based on secondary sources, zinc acts as an oxidizing agent, which may inhibit bromelain activity when these two agents are used together.

    • Bromelain/Food Interactions:

  • PotatoPotato: Based on secondary sources, potato protein may lead to the inhibition of bromelain activity.
  • SoySoy: Based on secondary sources, soybean protein may lead to the inhibition of bromelain activity.
  • Trypsincontaining foodsTrypsincontaining foods: Based on animal study, bromelain and trypsin may have a synergistic effect (65). Bromelain may react with other proteases like papain, some grass pollens, and wheat and rye flour (66; 67).

    • Bromelain/Lab Interactions:

  • Coagulation panelCoagulation panel: Based on in vitro, animal, and human study, bromelain may increase serum prothrombin time, plasma antithrombin time, and serum plasmin concentration (38), reduce platelet sensitivity to adenosine diphosphate (ADP) (39), and decrease platelet count (4).
  • Complete Blood Count (CBC)Complete Blood Count (CBC): In animal study, bromelain treatment resulted in reduced total BAL leukocytes and eosinophils (5).
  • Electrolyte levelsElectrolyte levels: Ananas comosus contains varying levels of minerals, such as potassium (68); bromelain has been found to contain calcium (69).
  • Heart rateHeart rate: In human study, bromelain (Anavit-F3?, containing 230mg of bromelain of 1,200 gelatin digestion units per gram and 15mg of ascorbic acid), in recommended doses, did not have any effect on heart rate in hypertensive patients (34). However, when the dose was increased eight-fold, there was a proportional increase in heart rate, but not in blood pressure.
  • T-lymphocyte countT-lymphocyte count: In animal study, bromelain treatment resulted in reduced CD4+ and CD8+ T lymphocytes and CD4+/CD8+ T cell ratio (5).