Bromelain

Overview

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 antibiotics.

Dietary Sources

Bromelain is one of the simple digestive enzymes that is extracted from tropical fruits, in this case pineapples.

Constituents/Composition

Bromelain A and B, the proteolytic enzymes of pineapples, constitute bromelain. Bromelain also consists of peroxidase, acid phosphatase, protease inhibitors, and calcium.

Commercial Preparations

Bromelain is available in tablet (500 mg) or capsule form for oral use.

Therapeutic Uses

• 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 animals.
• 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 and chemotherapeutic agents. By increasing absorption and tissue penetration, bromelain may potentiate the actions of chemotherapeutic agents and antibiotics. It has been shown to result in tumor regression when used in combination with selected chemotherapeutic agents.
• AIDS. Bromelain is a natural protease inhibitor (a protein-digesting enzyme) that may prove useful in the treatment of AIDS patients to control the replication of HIV. It is less expensive and is associated with fewer side effects than the protease inhibitors that are currently used for this function. More study is needed on bromelain's clinical usefulness in treating persons with HIV and AIDS.
• 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 sinusitis.
• Peyronie's disease. The deposition of fibrin, which is responsible for the thickening of the fibrous connective tissue in the penis, can be prevented with bromelain.
• Wound debridement. Bromelain as a topical agent can accelerate the healing of burns.
• Antimetastatic. Several studies suggest use as an antimetastatic agent with chemotherapy.

Dosage Ranges and Duration of Administration

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 stomach
• Cardiovascular disease—500 to 750 mg tid on an empty stomach
• Joint inflammation—500 to 2,000 mg/day in two doses
• Antitumor activity—1,000 mg/day

The standard duration of administration is 8 to 10 days, but longer periods are tolerated.

Side Effects/Toxicology

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 defects.

Warnings/Contraindications/Precautions

• 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.

Interactions

Amoxicillin

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 effects.

Tetracycline

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) (Bradbrook 1978).

References

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