Bromelain

Bromelain Adverse Reactions and Interactions:

As mentioned above by Brien S et al, more safety data is needed but research thus far completed reveals no serious adverse reactions, and was tolerated well. Adverse effects were mainly confined to mild gastrointestinal symptoms.  Research demonstrated that bromelain has caused reduction in prostaglandin synthesis, decreased platelet aggregation, compromised coagulation and has been shown to increase prothrombin time a small amount. (3).

Assessment and Plan: Bromelain

• The most evidence for the use of bromelain is seen in studies which outline the treatment of osteoarthritis.

• For osteoarthritis of the knee, bromelain was used in studies at a dose of 540 to 1890 mg per day. Several studies did show equivalence to diclofenac for osteoarthritis, but concerns remain by the author that studies did not treat long enough, had concerns in methodology, the ideal dose of bromelain was not defined, and subjects were not evaluated well enough for adverse reactions but the safety reports completed revealed no serious adverse reactions, and was tolerated well by patients.

• Adverse effects of bromelain were mainly confined to mild gastrointestinal symptoms.

• Bromelain is not without risks and may have the potential to cause GI bleeding due to reduced prostaglandin synthesis much like non-steroidal anti-inflammatory drugs can. Also it may increase risk of bleeding due to decreased platelet aggregation, increased prothrombin time (PT) and should not be taken by patients with bleeding disorders, by patients taking antiplatelet agents, or by patients taking anticoagulants such as the following: non-steroidal anti-inflammatory drugs (NSAIDs), warfarin (Coumadin), heparin, Plavix, ticlodipine, and aspirin.