Bromelain

The term "bromelain" is a (single) name for 2 enzymes from the protease family. These are sulfhydryl-containing cysteine proteases (glycoproteins) obtained from the fruit stalks of Ananas cosmosus (Fam Bromeliaceae). Bromelain is sparingly soluble in water and sparingly soluble in ethanol and ether. The enzyme develops its optimal proteolytic activity in the range of pH 4 -10.

Also called bromelain are the extracts obtained from pineapple, which, in addition to cysteine proteases, contain papain-like endopeptidases, several protease inhibitors, a peroxidase, acid phosphatase, and organically bound calcium .

Commission E-monography: acute swelling states, postoperative, post-traumatic, especially facial area, paranasal sinuses.

Empirical medicine: sports injuries, traumatic edema, thrombophlebitis, rheumatic diseases, digestive problems in pancreatic insufficiency.

Bromelain and the enzymes exogenously supplied with it are partially absorbed as intact proteins via the gastrointestinal tract. In humans, measurable concentrations of bromelain-specific proteases can be detected by quantitative determination procedures proportional to the administered dose (Castell 1997). The highest bromelain blood concentrations are found approximately 1 hour after oral administration. In the blood, bromelain is rapidly complexed to alpha2-macroglobulin (AMG) while maintaining specific enzyme activity (Kelly GS -1996; Maurer HR 2001). The bromelain effects are detectable as early as 20-60 minutes after oral application and subside after about 24 hours.

Bromelain effects are described as anti-edematous, anti-inflammatory, antithrombotic and fibrinolytic (Cooreman WM-1976, Leipner J et al.2001, Taussig SJ 1998). The large number of preclinical, pharmacological, animal and cell experimental findings provide a secure scientifically founded basis for further randomized and controlled clinical intervention studies.

The monopreparation bromelain was monographed in 1994 by Commission E with suggestions for dosage and indications.

• Systemic use: Medicinally, bromelaiin preparations are preferably used as adjunctive therapy in diseases with inflammatory, post-traumatic and -operative soft tissue oedema. They are therefore also of medical interest, especially in sports medicine and traumatology. In the treatment of sports injuries with post-traumatic swelling and oedema conditions, bromelad administration represents an alternative to therapy with non-steroidal anti-inflammatory drugs (NSAIDs).
• postoperative swelling for 4-5 days

Furthermore:

• Substitution therapy for digestive disorders
• Technically, the drug is used in the pre-treatment of meat (softening effect).

In addition to allergic reactions, occasional gastrointestinal symptoms such as diarrhea and stomach discomfort have been described as temporary side effects.

Prolongation of bleeding time, reduction of platelet aggregation.

Discontinue before planned operations!

Initial dose 4x40mg/p.o./day; maintenance dose 4x20mg/p.o./day.

Bromelain Pos 1 Kps contains 500 F.I.P. units, corresponding to 56.25-95 mg bromelain

Taking anticoagulants. Possible hypersensitivity to bromelain. Pregnancy, lactation (no clinical information available). Planned surgery

Possible increase of the bleeding tendency with simultaneous therapy with anticoagulants and platelet aggregation inhibitors.

Monopreparations:

• Bromelain-POS®, Traumanase®, Traumanase forte®, Wobenzym mono® (D), Bromelain-R.A.N®.

Combination preparations:

• Innovazym® , Phlogenzym®, Wobenzym®, DOG TG.

Bromelain is used medicinally both as a mono-preparation and as a combination preparation.

1. Castell JV et al (1997) Intestinal absorption of undegraded proteins in men: presence of bromelain in plasma after oral intake. Am J Physiol 273 139-146.
2. Chandler DS et al (1998) Bromelain protects piglets from diarrhea caused by oral challenge with K88 positive enterotoxigenic Escherichia coli. Gut 43: 196-202.
3. Cooreman WM etg al (1976) Bromelain, biochemical and pharmacological properties. Pharm Acta Helv 51: 73-97.
4. Kelly GS (1996) Bromelain: A literature review and discussion of its therapeutic applications. Alt Med Rev 1: 243-257.
5. Leipner J et al (2001) Therapy with proteolytic enzymes in rheumatic disorders. Bio Drugs 15: 779-789.
6. Maurer A (1996) On the bioavailability of bromelain contained in two different formulations after multiple oral dosage. Eur J Clin Pharmacol 50: 549.
7. Maurer HR (2001) Bromelain: biochemistry, pharmacology and medical use. Cell Mol Life Sci 58: 1234-1245.
8. Pavan R et al (2012) Properties and therapeutic application of bromelain: a review. Biotechnol Res Int:976203.
9. Rathnavelu V et al. (2016) Potential role of
10. bromelain in clinical and therapeutic applications. Biomed Rep 5:283-288.
11. Taussig SJ et al (1988) Bromelain, the enzyme complex of pineapple (Ananas comosus) and its clinical application. An update. J Ethnopharmacol 22:191-203.
12. Wenigmann M. (2017) Phytotherapy medicinal drugs, phytopharmaceuticals, application. Urban & Fischer, p. 90