Ananas comosus; Bromelainum
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.
- Nausea and vomiting
- Excessive menstrual bleeding
- Warfarin (Coumadin)
- Clopidogrel (Plavix)
- Anti seizure medications, such as phenytoin (Dilantin) and valproic acid (Depakote)
- 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)
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.
How to Take ItPediatric
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:
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:
Some experts believe bromelain may make sedative drugs stronger, including:
The same is true of herbs with a sedating effect, such as valerian, kava, and catnip.
Adachi N, Koh CS, Tsukada N, Shoji S, Yanagisawa N. In vitro degradation of amyloid material by four proteases in tissue of a patient with familial amyloidotic polyneuropathy. J Neurol Sci. 1988;84(2-3):295-299.
Aichele K, Bubel M, Deubel G, Pohlemann T, Oberringer M. Bromelain down-regulates myofibroblast differentiation in an in vitro wound healing assay. Naunyn Schmiedebergs Arch Pharmacol. 2013;386(10):853-863.
Bloomer RJ. The role of nutritional supplements in the prevention and treatment of resistance exercise-induced skeletal muscle injury. Sports Med. 2007;37(6):519-532. Review.
Blumenthal M, Goldberg A, Brinkman J, eds. Herbal Medicine. Expanded Commission E Monographs. Boston, Mass: Integrative Medicine Communications; 2000:33-35.
Bradbrook JD. The effect of bromelain on the absorption of orally administered tetracycline. Br J Clin Pharmacol. 1978;6(6):552-554.
Brien S, Lewith G, Walker AF, et al. Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study. QJM. 2006;99(12):841-850.
Buttner L, Achilles N, Bohm M, Shah-Hosseini K, Mosges R. Efficacy and tolerability of bromelain in patients with chronic rhinosinusitis--a pilot study. B-ENT. 2013;9(3):217-225.
Chobotova K, Vernallis AB, Majid FA. Bromelain's activity and potential as an anti-cancer agent: Current evidence and perspectives. Cancer Lett. 2010;290(2):148-156. Review.
Felton GE. Fibrinolytic and antithrombotic action of bromelain may eliminate thrombosis in heart patients. Med Hypotheses. 1980;6(11):1123-1133.
Guo R, Canter PH, Ernst E. Herbal medicines for the treatment of rhinosinusitis: a systematic review. Otolaryngol Head Neck Surg. 2006;135(4):496-506. Review.
Helms S, Miller A. Natural treatment of chronic rhinosinusitis. Altern Med Rev. 2006;11(3):196-207.
Ho D, Jagdeo J, Waldorf HA. Is There a Role for Arnica and Bromelain in Prevention of Post-Procedure Ecchymosis or Edema? A Systematic Review of the Literature. Dermatol Surg. 2016;43(4):445-63.
Kalra N, Bhui K, Roy P, et al. Regulation of p53, nuclear factor kappaB and cyclooxygenase-2 expression by bromelain through targeting mitogen-activated protein kinase pathway in mouse skin. Toxicol Appl Pharmacol. 2008;226(1):30-37.
Klein G, Kullich W. Short-term treatment of painful osteoarthritis of the knee with oral enzymes. A randomized, double-blind study versus diclofenac. Clin Drug Invest. 2000;19(1):15-23.
Klein G, Kullich W, Schnitker J, Schwann H. Efficacy and tolerance of an oral enzyme combination in painful osteoarthritis of the hip. A double-blind, randomised study comparing oral enzymes with non-steroidal anti-inflammatory drugs. Clin Exp Rheumatol. 2006;24(1):25-30.
Masson M. Bromelain in blunt injuries of the locomotor system. A study of observed applications in general practice. Fortschr Med. 1995;113(19):303-306.
Mori S, Ojima Y, Hirose T, Sasaki T, Hashimoto Y. The clinical effect of proteolytic enzyme containing bromelain and trypsin on urinary tract infection evaluated by double blind method. Acta Obstet Gynaecol Jpn. 1972;19(3):147-153.
Muller A, Barat S, Chen X, et al. Comparative study of antitumor effects of bromelain and papain in human cholangiocarcinoma cell lines. Int J Oncol. 2016;48(5):2025-2034.
Mynott TL, Guandalini S, Raimondi F, Fasano A. Bromelain prevents secretion cased by Vibrio cholerae and Escherichia coli enterotoxins in rabbit ileum in vitro. Gastroenterol. 1997;113(1):175-184.
Onken JE, Greer PK, Calingaert B, Hale LP. Bromelain treatment decreases secretion of pro-inflammatory cytokines and chemokines by colon biopsies in vitro. Clin Immunol. 2008;126(3):345-352.
Orsini RA; Plastic Surgery Educational Foundation Technology Assessment Committee. Bromelain. Plast Reconstr Surg. 2006;118(7):1640-1644. Review.
Pillai K, Akhter J, Chua TC, Morris DL. Anticancer property of bromelain with therapeutic potential in malignant peritoneal mesothelioma. Cancer Invest. 2013;31(4):241-250.
Rakel D, ed. Integrative Medicine. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012.
Rosenberg L, Lapid O, Bogdanov-Berezovsky A, et al. Safety and efficacy of a proteolytic enzyme for enzymatic burn debridement: a preliminary report. Burns. 2004;30(8):843-850.
Sanders HJ. Therapy of chlamydia infections with tetracyclines. Int J Exp Clin Chemother. 1990;3(2):101-106.
Secor ER, Carson WF, Singh A, et al. Oral bromelain attenuates inflammation in an Ovalbumin-induced Murine Model of Asthma. Evid Based Complement Alternat Med. 2008;5(1):61-69.
Szczurko O, Cooley K, Mills EJ, Zhou Q, Perri D, Seely D. Naturopathic treatment of rotator cuff tendinitis among Canadian postal workers: a randomized controlled trial. Arthritis Rheum. 2009;61(8):1037-1045.
Taussig SJ, Batkin S. Bromelain, the enzyme complex of pineapple (Ananas comosus) and its clinical application. An update. J Ethnopharmacol. 1988;22(2):191-203.
Walker JA, Cerny FJ, Cotter JR, Burton HW. Attenuation of contraction-induced skeletal muscle injury by bromelain. Med Sci Sports Exerc. 1992;24(1):20-25.
Wu SY, Hu W, Zhang B, Liu S, Wang JM, Wang AM. Bromelain ameliorates the wound microenvironment and improves healing of firearm wounds. J Surg Res. 2012;176(2):503-509.
Review Date: 1/1/2017
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M Editorial team.