Bromelain is a proteolytic digestive enzyme that is extracted from the stem
and the fruit of the pineapple plant (Ananas comosus). It is best known
as a digestive aid and for its anti-inflammatory effects in soft tissue injury
and edema. However, bromelain has been used successfully to treat a number of
disorders including cardiovascular disease, joint disease, upper respiratory
tract infection, and Peyronie's disease. Bromelain has also been used
successfully to debride wounds and to potentiate the actions of
Bromelain is one of the simple digestive enzymes that is extracted from
tropical fruits, in this case pineapples.
Bromelain A and B, the proteolytic enzymes of pineapples, constitute
bromelain. Bromelain also consists of peroxidase, acid phosphatase, protease
inhibitors, and calcium.
Bromelain is available in tablet (500 mg) or capsule form for oral
- Traumatic injuries and surgery. Bromelain's anti-inflammatory effects
reduce the pain, bruising, and swelling from trauma (e.g., sports injuries) or
surgery and speed the healing process. (The pain reduction is probably due to
decreased tissue inflammation rather than to a direct analgesic effect.)
- Digestive aid. Bromelain has been used as a digestive enzyme,
especially in patients with pancreatic insufficiency. It has been known to
relieve gastrointestinal upset in humans and to heal ulcers in experiments in
- Cardiovascular disease. Bromelain can relieve the symptoms of angina
pectoris, inhibit platelet aggregation and clot formation, and break down
arterial plaques by promoting fibrolysis; thus, it can be used to treat angina,
thrombosis, thrombophlebitis, varicose veins, and atherosclerosis.
- Joint inflammation. Because bromelain's anti-inflammatory effects
reduce joint inflammation, it can be used for rheumatoid arthritis,
osteoarthritis, sciatica, bursitis, tendinitis, and scleroderma.
- Potentiation of antibiotics. By increasing absorption and tissue
penetration, bromelain may potentiate the actions of antibiotics.
- Upper respiratory tract infections. Bromelain has demonstrated
effectiveness in suppressing mucolytic cough and decreasing bronchial
secretions, resulting in increased lung function in patients with upper
respiratory tract infections. It has also proved effective in patients with
- Peyronie's disease. The deposition of fibrin, which is responsible for
the thickening of the fibrous connective tissue in the penis, can be prevented
- Wound debridement. Bromelain as a topical agent can accelerate the
healing of burns.
|Dosage Ranges and Duration of
For use as a digestive aid, 500 mg with meals are recommended. For other
uses, the following dosages are recommended:
- Traumatic injuries—500 mg qid on an empty
- Cardiovascular disease—500 to 750 mg tid on
an empty stomach
- Joint inflammation—500 to 2,000 mg/day in two
The standard duration of administration is 8 to 10 days, but longer periods
Bromelain may cause nausea, vomiting, diarrhea, metrorrhagia, and
hypermenorrhea, but no serious side effects have been reported in humans.
Experiments in animals have not shown bromelain to cause cancer or birth
- Allergic reactions, including skin reactions and asthma, may occur if
the patient is allergic to pineapples.
- Caution must be used in patients with coagulation disorders and liver
or kidney disease.
- Caution must be used in patients with hypertension.
- No data are available for use during pregnancy.
In a double-blind, clinical study with 127 patients, coadministration of
bromelain (80 mg po) and amoxicillin (500 mg) increased concentrations of the
antibiotic in the blood, organs, and tissues three and six hours after treatment
(Tinozzi and Venegoni 1978). More research is needed to confirm these
Bromelain may increase the absorption and bioavailability of tetracycline. A
randomized study involving 36 patients with chlamydia infections investigated
the efficacy of tetracycline hydrochloride (1000 mg/day) plus bromelain (160
mg/day) against treatment with doxycycline (200 mg/day) alone (Sanders 1990).
After one week, the infectious pathogen was eliminated in 66.7% of patients in
the tetracycline plus bromelain group as compared to 55.6% in the doxycycline
group; by day 14, no infection was detected in either group. However, an earlier
study reported no effect on absorption or elimination of tetracycline when
patients were coadministered bromelain (80 mg) with tetracycline (500 mg)
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