Bromelain + Trypsin

• Acute and Chronic Inflammatory Conditions:
• Adjunctive treatment to reduce inflammation and edema in conditions such as trauma, surgical injuries, burns, and sports injuries.
• Postoperative Edema and Inflammation:
• Used to decrease swelling and pain following surgery, dental procedures, or musculoskeletal injuries.
• Thrombophlebitis and Venous Disorders:
• Adjunct to improve microcirculation and reduce inflammation in superficial thrombophlebitis and chronic venous insufficiency.
• Sinusitis and Respiratory Tract Inflammation:
• Supportive treatment for sinus congestion and inflammation.
• Off-label Uses:
• May be used to aid wound healing and improve absorption of antibiotics in some cases.

• Adults:
• Typical oral dose varies by formulation but commonly ranges from 500 mg to 1000 mg of bromelain combined with 50 mg to 100 mg of trypsin per day.
• Administered in divided doses, usually 2-3 times daily on an empty stomach for better absorption.
• Pediatrics:
• Safety and efficacy not well established; use only if benefits outweigh risks.
• Elderly:
• Dose adjustment not usually necessary but monitor for tolerability.
• Renal or Hepatic Impairment:
• No specific dose adjustments recommended; caution advised due to limited data.
• Administration:
• Oral capsules or tablets swallowed whole with water; should be taken away from meals for optimal absorption.

Bromelain is a proteolytic enzyme derived from pineapple stems that exhibits anti-inflammatory, anti-edematous, and fibrinolytic properties by breaking down proteins involved in inflammation and promoting clearance of inflammatory mediators. Trypsin is a pancreatic serine protease that hydrolyzes peptide bonds and assists in breaking down proteinaceous debris at the site of inflammation. The combination synergistically reduces local edema and pain by facilitating fibrin degradation, enhancing microcirculation, and modulating immune responses, thereby accelerating resolution of inflammation and tissue repair.

• Absorption:
• Bromelain and trypsin are absorbed partially through the gastrointestinal tract in active forms.
• Oral bioavailability varies; bromelain shows systemic proteolytic activity post-absorption.
• Distribution:
• Distributed to plasma and tissues, particularly at sites of inflammation.
• Metabolism:
• Metabolized by proteolytic enzymes and peptidases in plasma and liver.
• Elimination:
• Primarily excreted via urine as inactive metabolites.
• Half-life:
• Variable; bromelain’s systemic proteolytic activity can persist for several hours.

• Pregnancy:
• No formal FDA pregnancy category assigned.
• Limited data on safety; use only if clearly needed and after risk-benefit assessment.
• Lactation:
• Data lacking on excretion into breast milk; caution advised during breastfeeding.

• Primary Class: Proteolytic Enzyme Combination
• Subclass: Anti-inflammatory and Fibrinolytic Agents

• Known hypersensitivity to bromelain, trypsin, or other proteolytic enzymes
• Active bleeding disorders or patients receiving anticoagulant therapy with increased bleeding risk
• Peptic ulcer disease or gastrointestinal bleeding
• Severe hepatic or renal impairment (relative contraindication)

• Use cautiously in patients with bleeding disorders or taking anticoagulants due to increased bleeding risk.
• Monitor for allergic reactions, especially in patients with pineapple allergy or asthma.
• Discontinue if signs of hypersensitivity such as rash, itching, or swelling occur.
• Use cautiously in patients with renal or hepatic impairment.
• Avoid concurrent use with other fibrinolytics without medical supervision.

Common:

• Gastrointestinal discomfort (nausea, diarrhea)
• Allergic skin reactions (rash, itching)

Less Common / Rare:

• Hypersensitivity reactions including angioedema and anaphylaxis (rare)
• Increased bleeding tendency or bruising
• Mouth or throat irritation

• Anticoagulants and Antiplatelet Drugs: Increased risk of bleeding and bruising.
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Potential additive bleeding risk.
• Other Fibrinolytic Agents: Additive effects may increase bleeding risk.
• Oral Antibiotics: Bromelain may enhance absorption of certain antibiotics (e.g., tetracyclines, penicillins).

• Recent clinical guidelines recognize bromelain + trypsin combination as an effective adjunct for reducing inflammation and edema in musculoskeletal injuries and postoperative care.
• Emphasis on caution with concomitant anticoagulant therapy due to bleeding risks.
• No major changes in approved indications or dosing reported recently.

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from moisture, heat, and direct sunlight.
• Keep in tightly closed container.
• Keep out of reach of children.