Bromelain is a mixture of enzymes found in pineapples (Ananas comosus) that digest protein (proteolytic). Pineapple has been used for centuries in Central and South America to treat indigestion and reduce inflammation. Bromelain, which is derived from the stem and juice of the pineapple, was first isolated from the pineapple plant in the late 1800s. The German Commission E approved bromelain to treat swelling and inflammation after surgery, particularly sinus surgery.

Bromelain can be used to treat a number of conditions, but it is particularly effective in reducing inflammation from infection and injuries.

Surgery, Sprains and Strains, and Tendinitis

Although studies show mixed results, bromelain may reduce swelling, bruising, healing time, and pain after surgery and physical injuries. It is often used to reduce inflammation from tendinitis, sprains and strains, and other minor muscle injuries. Studies of people having dental, nasal, and foot surgeries found it reduced inflammation. In Europe, bromelain is used to treat sinus and nasal swelling following ear, nose, and throat surgery or trauma.

Wounds and Burns

Studies in animals suggest that bromelain, when applied to the skin, may be useful in removing dead tissue from third-degree burns, a process called debridement. One preliminary study of a debridement agent that is derived from bromelain to treat people with second- and third-degree burns showed a benefit. Severe burns require a doctor's care. Do not apply bromelain to broken skin.

Sinusitis (Sinus Inflammation)

Although not all studies agree, bromelain may help reduce cough and nasal mucus associated with sinusitis. It may also relieve the swelling and inflammation caused by hay fever.

Arthritis

Studies show mixed results. One study suggested that a combination of bromelain, rutosid and trypsin worked as well for reducing knee pain from osteoarthritis as nonsteroidal anti-inflammatory drugs (NSAIDs), which are commonly used pain relievers. NSAIDs include ibuprofen (Advil or Motrin), naproxen (Aleve), and diclofenac (Voltaren), among others.

Early studies suggest that bromelain may also help reduce pain in people with rheumatoid arthritis. More research is needed.

Infection

Evidence from test tube and animal studies suggests that bromelain can kill some viruses and bacteria. More research, including human studies, is needed to see whether it truly works.

Cancer

Preliminary research suggests that bromelain has anti-tumor properties, and may enhance the effectiveness of certain chemotherapy drugs. More research is needed.

Bromelain is found in the common pineapple plant, but not in high enough doses to act as medicine.

Bromelain is available in tablet or capsule form for use by mouth. A topical variety is sometimes used by health care providers to treat severe burns. Never try to treat a severe burn yourself. Always see a provider.

Pediatric

DO NOT give bromelain to a child. There are no studies to know if it's safe or not.

Adults

The German Commission E recommends 80 to 320 mg, 2 to 3 times per day. For specific conditions, higher doses may be prescribed.

Supplements may have side effects or interact with medications. You should take them only under the supervision of a knowledgeable health care provider. Bromelain is generally recommended for no longer than 8 to 10 consecutive days.

Side effects from bromelain are generally mild and include:

• Nausea and vomiting
• Diarrhea
• Excessive menstrual bleeding

People who are allergic to pineapples, Latex, wheat, celery, papain, carrot, fennel, cypress pollen, or grass pollen may also be allergic to bromelain.

Pregnant women and people with bleeding disorders, high blood pressure, and liver or kidney disease should not take bromelain.

Bromelain may increase the risk of bleeding during and after surgery. You should stop taking bromelain at least 2 weeks before surgery.

If you are being treated with any of the following medications, you should not use bromelain without talking to your health care provider.

Antibiotics

Bromelain may increase the amount of antibiotics absorbed by the body. In one clinical study, the combination of bromelain and amoxicillin raised levels of amoxicillin in the blood. Also, some studies suggest that bromelain may increase the body's absorption of tetracycline, another antibiotic. But results of other studies have been conflicting.

Blood thinners (anticoagulants and antiplatelet drugs)

Bromelain may affect the blood's ability to clot. When taken with blood thinners, it could raise the risk of bleeding. Some blood-thinning drugs include:

• Warfarin (Coumadin)
• Clopidogrel (Plavix)
• Aspirin

Sedatives

Some experts believe bromelain may make sedative drugs stronger, including:

• Anti seizure medications, such as phenytoin (Dilantin) and valproic acid (Depakote)
• Barbiturates
• Benzodiazepines, such as alprazolam (Xanax) and diazepam (Valium)
• Drugs to treat insomnia, such as zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta), and ramelteon (Rozerem)
• Tricyclic antidepressants, such as amitriptyline (Elavil)
• Alcohol

The same is true of herbs with a sedating effect, such as valerian, kava, and catnip.

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