Overview

Bromelain is an enzyme found in pineapples. It is available over the counter as a supplement and in some skin care products. It is used for many different reasons, but its benefits for most uses are not well defined. Common side effects may include diarrhea, upset stomach, or a burning or tingling sensation. Before using bromelain, make sure to tell your health care provider about any health conditions you have or medicines you are taking.

Uses

What is bromelain used for?

Bromelain is used for various reasons, although its benefits are not well defined. Some common reasons that people use bromelain include the following.

• Indigestion
• Muscle soreness after exercise
• Osteoarthritis
• Sinus infections
• To improve blood flow

Note: The FDA has not reviewed bromelain for safety and effectiveness. Learn more about cosmetics here. Learn more about dietary supplements here.

Bromelain is available as a dietary supplement in various strengths and dosage forms. It is also available in creams, sprays, or gels that are applied to the skin. NexoBrid (anacaulase) is a prescription form of bromelain gel that is applied to severe burns by a health care provider.

How does bromelain work (mechanism of action)?

Bromelain is an enzyme that breaks down proteins (a protease). It occurs naturally in pineapples (Ananas comosus) and is sometimes called pineapple enzyme or pineapple protease. Bromelain powder is commonly used in the kitchen as a meat tenderizer. This enzyme is also available as a dietary supplement and in creams, sprays, or gels that are applied to the skin.

Bromelain may have many different effects on your body. Since it is an enzyme that breaks down protein, taking bromelain may help you break down the foods you eat a little bit faster. But it is unclear if this can help ease symptoms of indigestion.

Bromelain may also help reduce swelling (inflammation) and break up blood clots. Some research shows that taking bromelain after wisdom tooth removal can help reduce pain. But the benefits of taking bromelain to improve blood flow, or for other conditions that involve inflammation, are not well defined.

Applying bromelain to wounds may help break down dead skin (debridement) and speed up the healing process. When a prescription form of bromelain, called NexoBrid, is applied to severe burns by a health care provider, it can help improve healing. This prescription gel contains a much higher concentration of bromelain than products found over-the-counter. Over-the-counter products are not expected to work the same way as prescription bromelain.

Bromelain is also added to some skin care products that are meant to break down dead skin cells and increase skin brightness. However, the benefits of bromelain for skin care are not well defined.

How should I store bromelain?

You should store bromelain according to the product label. Most dietary supplements should be kept in a cool, dry location that is out of the reach of children and pets and not in direct sunlight.

Side Effects

What are the most common side effects of bromelain?

The most common side effects of bromelain are listed below. These side effects may vary depending on the dose you are taking or the specific product you are using. Tell your health care provider if you have any of these side effects that bother you.

• Burning or tingling in the mouth or throat
• Diarrhea
• Upset stomach

There may be side effects of bromelain that are not listed here. Contact your health care provider if you think you are having a side effect of a supplement. In the U.S., you can report side effects to the FDA at www.safetyreporting.hhs.gov or by calling 888-SAFEFOOD (888-723-3366). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of bromelain?

While less common, the most serious side effects of bromelain are described below, along with what to do if they happen.

Severe Allergic Reactions. Bromelain may cause allergic reactions, which can be serious. Stop using bromelain and get help right away if you have any of the following symptoms of a serious allergic reaction.

• Breathing problems or wheezing
• Racing heart
• Fever or general ill feeling
• Swollen lymph nodes
• Swelling of the face, lips, mouth, tongue, or throat
• Trouble swallowing or throat tightness
• Itching or skin rash
• Bumps on the skin called hives, which can be red, pink, white, or brown depending on your skin tone
• Nausea or vomiting
• Dizziness, feeling lightheaded, or fainting
• Stomach cramps
• Joint pain

Precautions

Who should not use bromelain?

Allergies to Ingredients. People who are allergic to any of the following should not use bromelain.

• Anacaulase
• Bromelain
• Bromelase
• Extranase
• Pineapples (Ananas comosus)
• Any of the ingredients in the specific product

Your pharmacist can tell you all of the ingredients in the specific bromelain products they stock.

Papaya or Papain Allergy.People with an allergy to papaya or an enzyme found in papaya, called papain, may be more likely to have an allergic reaction to bromelain or pineapple.

What should I know about bromelain before using it?

Bromelain is a dietary supplement. It cannot be marketed to treat or cure a disease.

Read and follow the directions on the specific product you are using, or use it as recommended by your health care provider.

Keep bromelain out of the reach of children.

Bromelain comes in many different forms, including as a powder, tablet, or capsule. It is also found in some creams, gels, or sprays that are applied to the skin. Each of these products may contain different amounts of bromelain, and many also contain other ingredients. Read the product label carefully to see which ingredients it contains.

Bromelain is an enzyme. If it stays in your mouth for too long, it can irritate your mouth, gums, and throat. If you are using bromelain powder, use a proper measuring device to measure the powder, such as the device included with the product. Mix the powder with the recommended amount of fluid and stir well to make sure that the powder is fully dissolved. Leaving clumps of powder in the fluid will increase your risk of mouth and throat irritation. Follow all instructions on the product label.

The FDA has not tested bromelain products to confirm that they contain the ingredients stated on their labels. Some dietary supplements have been tested by third-party organizations to confirm that they contain the ingredients listed on their labels and do not contain any harmful chemicals. Learn more about how to choose a safe dietary supplement product here.

What should I tell my health care provider before using bromelain?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if bromelain is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions.Tell your health care provider if you have any of the following.

• Bleeding problems
• Stomach problems, such as stomach ulcers

Other Medicines and Supplements.Bromelain may interact with other medicines and supplements. Before using bromelain, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. It is not known if or how bromelain could affect pregnancy or harm a fetus. Tell your health care provider if you are pregnant or plan to become pregnant.

Breastfeeding. It is not known if bromelain passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed.

Interactions

Does bromelain interact with foods or drinks?

There are no known interactions between bromelain and foods or drinks. It is unknown if drinking alcohol will affect bromelain.

Does bromelain interact with medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using bromelain.

• A blood thinner, which is a medicine used to treat or prevent blood clots
• An antiplatelet medicine, such as aspirin/dipyridamole, cilostazol, clopidogrel (Plavix), or ticagrelor (Brilinta), which is a medicine used to prevent blood clots
• A nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, naproxen, and others, which is present in many prescription and OTC products for pain, swelling, and fever

The interactions between bromelain and medicines are not fully understood. As with most dietary supplements, the research on drug interactions with bromelain is incomplete. Always check with your health care provider before using bromelain with any medicines.

Dosing

What should I do if I accidentally use too much bromelain?

If you or someone else has used too much bromelain, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

Read the product label closely and speak with a health care provider about how to use bromelain safely. Do not use double or extra doses, even if you miss a dose.