Bromelain

Background

• Bromelain is a group of enzymes that break down proteins. These enzymes are found in the stem and fruit of the pineapple plant. 
• Pineapple was traditionally used for medicinal purposes in South and Central America.
• Bromelain is promoted as a dietary supplement for a variety of purposes including postoperative pain after wisdom tooth extraction, sinusitis, osteoarthritis, and exercise-induced muscle soreness. Bromelain is used topically (applied to the skin) as a prescription drug in the treatment of serious burns. 

How Much Do We Know?

• A small number of studies have been done on the use of bromelain taken orally (by mouth) for reducing symptoms of sinusitis and reducing pain and swelling after wisdom tooth extraction. For other conditions, either very little research has been done or studies have only evaluated products that contain a mixture of bromelain and other ingredients, and therefore the effects of bromelain alone are unclear.
• In 2022, the U.S. Food and Drug Administration (FDA) approved a drug product containing bromelain for topical use for debridement (removal of dead tissue or contaminants) of severe burns in adults. The product is also approved for this purpose in the European Union.

What Have We Learned?

• There is not enough high-quality research to say whether oral bromelain should be recommended for sinusitis.
• Some studies suggest that oral bromelain might be helpful for reducing some symptoms associated with wisdom tooth surgery.
• Debridement with topical bromelain has been successfully administered by health professionals as an alternative to surgical debridement.

What Do We Know About Safety?

• When taken orally, bromelain seems to be well tolerated. The most commonly reported side effects have been stomach upset and diarrhea.
• If you take any type of medicine, talk with your health care provider before using bromelain or other herbal products; some herbs and medicines interact in harmful ways.
• Little is known about whether it’s safe to use bromelain during pregnancy or while breastfeeding.

Keep in Mind

• Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.
• Federal Regulation of Herbal Products
  • Depending on what’s in them, how they’re intended to be used, and how they’re administered (orally or topically), herbal products are regulated in a variety of ways. Many herbal products intended for oral use are marketed as dietary supplements. The rules for making and distributing dietary supplements are less strict than those for drugs.
  • Unlike drugs, dietary supplements are not approved by the FDA before they are sold to the public. When public health concerns arise about the safety of a dietary supplement or an ingredient including an herb, the FDA can take action to protect the public. Manufacturers and distributors of supplements are responsible for evaluating the safety and labeling of their products before marketing to ensure that they meet all regulatory requirements. 

For More Information

• Using Dietary Supplements Wisely
• Know the Science: How Medications and Supplements Can Interact
• Know the Science: How To Make Sense of a Scientific Journal Article

Key References