What is bromelain used for?

Bromelain is a mixture of protein-digesting (proteolytic) enzymes extracted from the fruit and stem of the pineapple plant. It is promoted as a dietary supplement with anti-inflammatory properties. Few studies support the wide range of promoted medical uses for bromelain. Evidence exists primarily for the use of bromelain in debridement of burns and as an anti-inflammatory agent.

Promoted uses include:

• to reduce swelling of the nose, sinuses or gums after surgery or injury
• to treat osteoarthritis, muscle soreness
• pain after dental surgery
• cancer
• digestive problems
• topical use to aid in the removal of dead skin or tissue in patients with serious skin burns.

There are a limited number of well-controlled research studies with bromelain. It is important to remember that information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration (FDA) and are not intended to diagnose, treat, cure, or prevent any disease or health condition. Speak with your healthcare provider for advice before you use bromelain.

Common names for bromelain include pineapple enzyme and pineapple extract. Other names for bromelain include:

• Ananas comosus
• Ananas
• Bromelaine
• Bromelains
• Bromelainum
• Bromelin
• Debridase
• Fruit Bromelain
• Phlogenzym
• Pineapple
• Pineapple Enzyme
• Pineapple Extract
• Plant Protease Concentrate
• Protease

Pineapple is native to South America but it is also grown throughout the world in tropical and subtropical climates. Costa Rica, the Philippines and Brazil are some of the world’s largest suppliers of pineapple.

Pineapple has a history of use as a medicinal product. In folk medicine, it has been used to aid with digestion. In the modern food industry, bromelain is often used as a meat tenderizer.

Can you buy bromelain in the US?

Yes, bromelain is sold as an oral over-the-counter (OTC) dietary supplement in the US at pharmacies, groceries and other retail outlets. It is also available in Japan and other countries around the world.

It is promoted as a proteolytic enzyme that:

• supports digestion of proteins
• has anti-Inflammatory properties that support joint health
• supports nutrient absorption

Bromelain is typically sold as a tablet, capsule, topical cream and as liquid extract. The most common strength of capsules and tablets is 500 mg. There is no standard dose that has been approved by the FDA.

The dose of bromelain suggested by manufacturers is 500 mg once or twice daily, but a wide range of doses are suggested. It is recommended not to take bromelain with food because it acts as a digestive enzyme.

There is not enough research to determine the effectiveness of bromelain for sinus or gum swelling, osteoarthritis, pain due to dental surgery, cancer, muscle soreness or injury after exercise, or digestive problems.

Is bromelain used for burns?

There is research to suggest that bromelain can help remove dead and damaged skin in adults and children with serious burns. Further research needs to be done to determine if it helps to prevent scarring. If you have a serious burn, contact your doctor or call 911 right away for assistance.

In the European Union and other international markets, a topical bromelain enzymatic product called NexoBrid is approved to be used by doctors in burn units to help remove dead tissue (eschar removal) in patients with serious thermal burns. It is made by MediWound.

• NexoBrid comes as a powder and gel, which are mixed together to make a gel. It is used in patients with deep partial and full-thickness thermal burns within four hours of application without harming viable tissue.
• In the US, NexoBrid is an investigational and orphan drug product under an expanded access protocol.
• Other products with proteolytic enzymes enriched in bromelain in development by MediWound include EscharEx, a bioactive therapy for debridement of chronic and other hard-to-heal wounds, and MW005, a topical biological drug for the treatment of non-melanoma skin cancers.

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What are bromelain side effects?

Not enough research has been done to fully determine the side effects of bromelain, but it does not appear to be associated with a high incidence of problems. The most common side effects appear to be stomach-related, like diarrhea and stomach upset.

Reported side effects of bromelain include:

• diarrhea
• flatulence (gas)
• heavy periods (menstrual bleeding)
• nausea, vomiting
• dry mouth
• allergic reactions
• skin irritation or rash
• mouth sores

Theoretically, bromelain may have blood thinning properties because it inhibits synthesis of fibrinogen and has fibrinolytic properties. This effect has been noted in animal studies. If you take a blood thinning agent, like warfarin, aspirin or other agents, speak with your doctor before you use bromelain.

Allergic reactions to bromelain may occur in people who are allergic to pineapples. Also, cross-sensitivity allergic reactions may occur if you are allergic to bee stings, foods like pineapple, papaya, or celery; cypress or olive oil tree pollens, ragweed, daisy aster, marigolds, papain or chrysanthemums.

Exposure of workers who cut pineapple to bromelain can cause disappearance of their fingerprints.

Higher doses of bromelain up to 1,840 mg have been shown to increase heart rate.

There is not sufficient data to determine if bromelain is safe to use in pregnancy or breastfeeding. If you are planning a pregnancy, pregnant or breastfeeding, speak to your healthcare provider before use.

Bottom Line

• Bromelain is a mixture of enzymes extracted from the pineapple plant. It is promoted as an over-the-counter (OTC) dietary supplement to help with pain and inflammation, digestion, or removal of dead skin after serious burns.
• Bromelain is available as a dietary supplement in the US as a tablet, capsule, cream or oral liquid extract. It is under research to be approved as a prescription product to remove dead tissue in patients with serious burns, for wound debridement, and for non-melanoma skin cancers.
• Well-conducted research is limited for bromelain and information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration (FDA) and are not intended to diagnose, treat, cure, or prevent any disease or health condition.

Speak with your doctor before using bromelain and have your healthcare provider review for any possible drug interactions.