No

Enzyme

Alternative to surgery in patients with herniated lumbar intervertebral discs

C

Hypersensitivity to chymopapain, papaya, or its derivatives; neurologic impairment; use in spondylolisthesis or cauda equina lesion

>10%: Neuromuscular & skeletal: Back pain

1% to 10%:

Central nervous system: Dizziness, headache

Gastrointestinal: Nausea

Neuromuscular & skeletal: Weakness in legs

Avoid discography (with intradiscal radiographic contrast media)

Store at 2°C to 8°C (36°F to 46°F); use within 2 hours of reconstitution

Chymopapain, when injected into the disc center, causes hydrolysis of the mucal mucopolysaccharide protein complex into acid polysaccharide, polypeptides, and amino acids. Subsequently, the water trapping properties of the nucleus pulposus are destroyed which permanently diminishes the pressure within the disc. The adjacent structures including the annulus fibrosus are not affected by chymopapain.

Adults: 2000-4000 units/disc with a maximum cumulative dose not to exceed 8000 units for patients with multiple disc herniations

May cause dizziness

None reported

No information available to require special precautions

No effects or complications reported

The risk of serious adverse reactions must be discussed with the patient

Patients should be well hydrated prior to chymopapain administration; anaphylactic reactions may occur up to 1 hour after injection; observe the patient closely

Injection: 4000 units [4 nKat]; 10,000 units [10 nKat]