NutriDex

The Supplement Research Compendium
🍍

Bromelain

Bromelain (pineapple enzyme)

Pineapple-stem enzyme used for swelling, pain and sinus symptoms.

Moderate evidence ✨Joint & Skin🛡️Gut & Immune

✚ Updated · How we grade evidence

Evidence tier
Moderate
Research weight
Citations
9 verified / 9
Classification
Joint & Skin
❝
What the evidence says. Graded moderate: a fixed enzyme-rutin combination matched diclofenac for knee osteoarthritis in pooled RCTs, and oral bromelain modestly cut pain after dental surgery, but most trials are small, use combination products, or are industry-linked, and swelling/sinusitis data are weaker. (Moderate evidence: Several controlled trials; effects real but modest or context-dependent.)

What is Bromelain?

Bromelain (Bromelain (pineapple enzyme)) is a joint and skin supplement used for ease post-surgical pain. NutriDex grades the human evidence as Moderate. Bromelain is a mix of protein-digesting (proteolytic) enzymes from the pineapple stem and fruit, sold for inflammation, swelling and sinus complaints. The strongest data are for osteoarthritis: a pooled reanalysis of six RCTs (N≈700) found a fixed bromelain-trypsin-rutin combination as effective as diclofenac for knee pain and function, with fewer GI side effects. After third-molar surgery a meta-analysis showed a small reduction in pain (standardized mean difference roughly -0.5 at 24 h and 7 days) but no clear benefit for swelling or jaw stiffness. A 2023 systematic review concluded bromelain may help sinusitis but not cardiovascular disease. Separately, a standardized topical bromelain (NexoBrid) is an approved enzymatic burn-wound debriding agent. Overall the oral evidence is real but modest, often relies on combination products, and dosing units (GDU/FIP) are not standardized across brands.

Purported Benefits

✓Ease post-surgical pain
✓Reduce swelling & bruising
✓Relieve sinusitis symptoms
✓Osteoarthritis (with trypsin/rutin)
✓Enzymatic burn debridement (topical)

Evidence by outcome

The same supplement can be well-proven for one use and unproven for another — here is the human evidence graded outcome by outcome.

OutcomeEvidenceEffectStudies
Knee osteoarthritis pain (with trypsin/rutin)Pooled reanalysis of 6 RCTs found a fixed bromelain-trypsin-rutin combo non-inferior to diclofenac; combination product, not bromelain alone. Moderate ↑ benefit · moderate 1
Post-surgical (third-molar) painMeta-analysis shows small pain reduction (SMD ~-0.5 at 24h/7d); no clear benefit on swelling or trismus. Moderate ↑ benefit · small 2
Reduce swelling & bruisingSurgical meta-analysis found no clear swelling/trismus benefit; a single RCT reported improvement, so evidence is inconsistent. Mixed ↔ mixed 1
Relieve sinusitis symptomsA systematic review suggests possible help; main support is one pediatric observational study, not RCTs. Preliminary ↑ benefit · small 2
Enzymatic burn-wound debridement (topical)Standardized topical bromelain (NexoBrid) is an approved debriding agent; faster eschar removal and less surgery. Topical, not oral. Strong ↑ benefit · large 2

Dosing & Compounds

Typical Dose
Oral: typically 200–400 mg/day (about 1,200–2,400 GDU or ~3,000–9,000 FIP), often as 80–320 mg 2–3×/day on an empty stomach; the OA evidence uses a fixed bromelain-trypsin-rutin combination.
Active Compounds
Cysteine proteases (stem & fruit bromelain)PeroxidasePhosphatase

Safety & Cautions

Generally well tolerated; the most common effects are GI upset (nausea, diarrhea, flatulence) and occasional headache. People allergic to pineapple, latex, grass or birch pollen can react (cross-reactivity), and severe allergic reactions are possible. Because of mild antiplatelet/fibrinolytic activity, theoretically it may add to bleeding risk with anticoagulants or antiplatelets (warfarin, aspirin, clopidogrel) and NSAIDs—stop before surgery; it may also increase blood levels of some antibiotics (amoxicillin, tetracyclines). Avoid in bleeding disorders and use caution in pregnancy and breastfeeding due to limited data. Educational only — always check with your doctor or pharmacist before combining Bromelain with any medicine.

Bromelain drug interactions

Known or theoretical interactions between Bromelain and common medications — educational, not exhaustive. Always check with your doctor or pharmacist before combining Bromelain with any medicine.

Caution
Blood thinners (warfarin, DOACs)
Bromelain may increase bleeding risk when combined with blood thinners.
Bromelain has fibrinolytic and antiplatelet activity that can add to anticoagulant effects. NCCIH — Bromelain
Caution
Antiplatelet drugs (aspirin, clopidogrel)
Bromelain with aspirin or clopidogrel may add to bleeding tendency.
Bromelain reduces platelet aggregation, compounding antiplatelet drugs. NCCIH — Bromelain

Key Studies

Meta-analysis Leelakanok 2023 ✓ PubMed
Systematic review/meta-analysis: oral bromelain modestly reduced pain vs control and may help sinusitis; no benefit for cardiovascular disease; no major safety signals.
Systematic review Hsu 2023 ✓ PubMed
Systematic review of bromelain-based enzymatic burn debridement: effective, selective eschar removal reducing surgical excision, with acceptable long-term outcomes.
Meta-analysis Ueberall 2016 ✓ PubMed
Pooled reanalysis of 6 RCTs (N=697): bromelain-trypsin-rutin combination non-inferior to diclofenac for knee OA (Lequesne diff 0.31, NS), with better tolerability.
Meta-analysis de la Barrera-Nunez 2019 ✓ PubMed
Meta-analysis of 6 RCTs after third-molar surgery: oral bromelain cut pain (SMD -0.49 at 24h; -0.52 at 7d) but no clear effect on swelling or trismus.
Safety LiverTox 2023 ✓ Full text
NIH monograph: oral bromelain at therapeutic doses has not been linked to liver enzyme elevations or clinically apparent liver injury.
RCT Ordesi 2014 ✓ PubMed
Double-blind RCT after mandibular third-molar surgery: perioperative bromelain reduced pain, swelling and improved quality-of-life measures vs placebo.
Safety Eckert 2011 ✓ PubMed
Review of perioperative bromelain found no clinical evidence of an enhanced bleeding tendency in surgical patients.
Review Hirche 2018 ✓ PubMed
Evidence appraisal of bromelain (NexoBrid) for deep partial/full-thickness burns: faster eschar removal and less surgery vs standard of care across trials.
Cohort Braun 2005 ✓ PubMed
Observational study in 116 children with acute sinusitis: bromelain monotherapy gave faster symptom recovery (6.7 vs 8.0 days standard care); one allergic reaction.
9 sources cited · 9 verified Search all studies on PubMed ↗

Common questions about Bromelain

What is Bromelain used for?

Bromelain is most often taken for Ease post-surgical pain, Reduce swelling & bruising, Relieve sinusitis symptoms, Osteoarthritis (with trypsin/rutin). Pineapple-stem enzyme used for swelling, pain and sinus symptoms.

Does Bromelain work — what does the evidence say?

Moderate evidence. Several controlled trials; effects real but modest or context-dependent. Bromelain is a mix of protein-digesting (proteolytic) enzymes from the pineapple stem and fruit, sold for inflammation, swelling and sinus complaints. The strongest data are for osteoarthritis: a pooled reanalysis of six RCTs (N≈700) found a fixed bromelain-trypsin-rutin combination as effective as diclofenac for knee pain and function, with fewer GI side effects. After third-molar surgery a meta-analysis showed a small reduction in pain (standardized mean difference roughly -0.5 at 24 h and 7 days) but no clear benefit for swelling or jaw stiffness. A 2023 systematic review concluded bromelain may help sinusitis but not cardiovascular disease. Separately, a standardized topical bromelain (NexoBrid) is an approved enzymatic burn-wound debriding agent. Overall the oral evidence is real but modest, often relies on combination products, and dosing units (GDU/FIP) are not standardized across brands.

What is the typical dose of Bromelain?

Oral: typically 200–400 mg/day (about 1,200–2,400 GDU or ~3,000–9,000 FIP), often as 80–320 mg 2–3×/day on an empty stomach; the OA evidence uses a fixed bromelain-trypsin-rutin combination.

Is Bromelain safe? Any cautions or side effects?

Generally well tolerated; the most common effects are GI upset (nausea, diarrhea, flatulence) and occasional headache. People allergic to pineapple, latex, grass or birch pollen can react (cross-reactivity), and severe allergic reactions are possible. Because of mild antiplatelet/fibrinolytic activity, theoretically it may add to bleeding risk with anticoagulants or antiplatelets (warfarin, aspirin, clopidogrel) and NSAIDs—stop before surgery; it may also increase blood levels of some antibiotics (amoxicillin, tetracyclines). Avoid in bleeding disorders and use caution in pregnancy and breastfeeding due to limited data.

How many studies support Bromelain?

NutriDex cites 9 sources for Bromelain, graded "Moderate".

Does Bromelain interact with any medications?

Yes — known or theoretical interactions include: Blood thinners (warfarin, DOACs) (caution), Antiplatelet drugs (aspirin, clopidogrel) (caution). This is educational and not exhaustive; always check with your doctor or pharmacist before combining Bromelain with any medicine.

Cite this page
APA

Peh, D. (2026). Bromelain (Bromelain (pineapple enzyme)): Benefits, Dosage, Side Effects & Evidence. NutriDex — The Supplement Research Compendium. Retrieved 26 Jun 2026, from https://nutridex.info/s/bromelain

BibTeX
@misc{nutridex_bromelain,
  author       = {Peh, Daryl},
  title        = {Bromelain (Bromelain (pineapple enzyme)): Benefits, Dosage, Side Effects \& Evidence},
  year         = {2026},
  howpublished = {NutriDex --- The Supplement Research Compendium},
  url          = {https://nutridex.info/s/bromelain},
  note         = {Reviewed by Dr Daryl Peh, MBBS Singapore, MMed FM. Accessed 2026-06-26}
}

For medical claims, citing the underlying primary studies linked above is preferred. NutriDex is an educational reference, not medical advice.

← Back to the full dex · All substances